|
HC SOM 22FP 88275 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.34 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.69
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
IP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$239.50 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.70
|
| Rate for Payer: EPIC Health Plan Senior |
$112.70
|
| Rate for Payer: Galaxy Health WC |
$239.50
|
| Rate for Payer: Global Benefits Group Commercial |
$169.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.62
|
| Rate for Payer: Multiplan Commercial |
$225.41
|
| Rate for Payer: Networks By Design Commercial |
$183.14
|
| Rate for Payer: Prime Health Services Commercial |
$239.50
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
OP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$2,585.40 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,585.40
|
| Rate for Payer: Blue Shield of California Commercial |
$188.50
|
| Rate for Payer: Blue Shield of California EPN |
$124.54
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Cigna of CA HMO |
$180.33
|
| Rate for Payer: Cigna of CA PPO |
$208.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Senior |
$51.19
|
| Rate for Payer: Galaxy Health WC |
$239.50
|
| Rate for Payer: Global Benefits Group Commercial |
$169.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$225.41
|
| Rate for Payer: Networks By Design Commercial |
$183.14
|
| Rate for Payer: Prime Health Services Commercial |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
IP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$92.63 |
| Max. Negotiated Rate |
$393.67 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.26
|
| Rate for Payer: EPIC Health Plan Senior |
$185.26
|
| Rate for Payer: Galaxy Health WC |
$393.67
|
| Rate for Payer: Global Benefits Group Commercial |
$277.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$286.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.15
|
| Rate for Payer: Multiplan Commercial |
$370.51
|
| Rate for Payer: Networks By Design Commercial |
$301.04
|
| Rate for Payer: Prime Health Services Commercial |
$393.67
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
OP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,675.72 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$303.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.72
|
| Rate for Payer: Blue Shield of California Commercial |
$309.84
|
| Rate for Payer: Blue Shield of California EPN |
$204.71
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Cigna of CA HMO |
$296.41
|
| Rate for Payer: Cigna of CA PPO |
$342.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$393.67
|
| Rate for Payer: Global Benefits Group Commercial |
$277.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$308.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$370.51
|
| Rate for Payer: Networks By Design Commercial |
$301.04
|
| Rate for Payer: Prime Health Services Commercial |
$393.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$277.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$277.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
OP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$2,585.40 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,585.40
|
| Rate for Payer: Blue Shield of California Commercial |
$202.47
|
| Rate for Payer: Blue Shield of California EPN |
$133.77
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Cigna of CA HMO |
$193.69
|
| Rate for Payer: Cigna of CA PPO |
$223.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Senior |
$51.19
|
| Rate for Payer: Galaxy Health WC |
$257.24
|
| Rate for Payer: Global Benefits Group Commercial |
$181.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Networks By Design Commercial |
$196.72
|
| Rate for Payer: Prime Health Services Commercial |
$257.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
IP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$257.24 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.06
|
| Rate for Payer: EPIC Health Plan Senior |
$121.06
|
| Rate for Payer: Galaxy Health WC |
$257.24
|
| Rate for Payer: Global Benefits Group Commercial |
$181.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$201.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$187.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.63
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Networks By Design Commercial |
$196.72
|
| Rate for Payer: Prime Health Services Commercial |
$257.24
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
IP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$99.51 |
| Max. Negotiated Rate |
$422.93 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.02
|
| Rate for Payer: EPIC Health Plan Senior |
$199.02
|
| Rate for Payer: Galaxy Health WC |
$422.93
|
| Rate for Payer: Global Benefits Group Commercial |
$298.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$331.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.41
|
| Rate for Payer: Multiplan Commercial |
$398.05
|
| Rate for Payer: Networks By Design Commercial |
$323.41
|
| Rate for Payer: Prime Health Services Commercial |
$422.93
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
OP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,675.72 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$326.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.72
|
| Rate for Payer: Blue Shield of California Commercial |
$332.87
|
| Rate for Payer: Blue Shield of California EPN |
$219.92
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Cigna of CA HMO |
$318.44
|
| Rate for Payer: Cigna of CA PPO |
$368.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Senior |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$422.93
|
| Rate for Payer: Global Benefits Group Commercial |
$298.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$331.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$398.05
|
| Rate for Payer: Networks By Design Commercial |
$323.41
|
| Rate for Payer: Prime Health Services Commercial |
$422.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$298.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 2 DAYS TURNAROUND 6800
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT U0005
|
| Hospital Charge Code |
900915350
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$166.24 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.24
|
| Rate for Payer: Blue Shield of California Commercial |
$18.06
|
| Rate for Payer: Blue Shield of California EPN |
$11.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.90
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$22.95
|
|
|
HC SOM 5-FLUOROCYTOSINE
|
Facility
|
IP
|
$34.02
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$28.92 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.61
|
| Rate for Payer: EPIC Health Plan Senior |
$13.61
|
| Rate for Payer: Galaxy Health WC |
$28.92
|
| Rate for Payer: Global Benefits Group Commercial |
$20.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$27.22
|
| Rate for Payer: Networks By Design Commercial |
$22.11
|
| Rate for Payer: Prime Health Services Commercial |
$28.92
|
|
|
HC SOM 5-FLUOROCYTOSINE
|
Facility
|
OP
|
$34.02
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$22.76
|
| Rate for Payer: Blue Shield of California EPN |
$15.04
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna of CA HMO |
$21.77
|
| Rate for Payer: Cigna of CA PPO |
$25.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$28.92
|
| Rate for Payer: Global Benefits Group Commercial |
$20.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$27.22
|
| Rate for Payer: Networks By Design Commercial |
$22.11
|
| Rate for Payer: Prime Health Services Commercial |
$28.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM 7-DEHYDROCHOLESTERL
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$66.90
|
| Rate for Payer: Blue Shield of California EPN |
$44.20
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM 7-DEHYDROCHOLESTERL
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY
|
Facility
|
OP
|
$26.81
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900912802
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$176.88 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.88
|
| Rate for Payer: Blue Shield of California Commercial |
$17.94
|
| Rate for Payer: Blue Shield of California EPN |
$11.85
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Cigna of CA HMO |
$17.16
|
| Rate for Payer: Cigna of CA PPO |
$19.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$22.79
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
| Rate for Payer: Networks By Design Commercial |
$17.43
|
| Rate for Payer: Prime Health Services Commercial |
$22.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY
|
Facility
|
IP
|
$26.81
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900912802
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$22.79 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.79
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
| Rate for Payer: Networks By Design Commercial |
$17.43
|
| Rate for Payer: Prime Health Services Commercial |
$22.79
|
|
|
HC SOM 8INHE FACTOR VIII INHIB TECH INTERP
|
Facility
|
OP
|
$23.19
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900911120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.94
|
| Rate for Payer: Blue Shield of California Commercial |
$15.51
|
| Rate for Payer: Blue Shield of California EPN |
$10.25
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Cigna of CA HMO |
$14.84
|
| Rate for Payer: Cigna of CA PPO |
$17.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$19.71
|
| Rate for Payer: Global Benefits Group Commercial |
$13.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$18.55
|
| Rate for Payer: Networks By Design Commercial |
$15.07
|
| Rate for Payer: Prime Health Services Commercial |
$19.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM 8INHE FACTOR VIII INHIB TECH INTERP
|
Facility
|
IP
|
$23.19
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900911120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.28
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$19.71
|
| Rate for Payer: Global Benefits Group Commercial |
$13.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$18.55
|
| Rate for Payer: Networks By Design Commercial |
$15.07
|
| Rate for Payer: Prime Health Services Commercial |
$19.71
|
|
|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
IP
|
$27.58
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Senior |
$11.03
|
| Rate for Payer: Galaxy Health WC |
$23.44
|
| Rate for Payer: Global Benefits Group Commercial |
$16.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Multiplan Commercial |
$22.06
|
| Rate for Payer: Networks By Design Commercial |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$23.44
|
|
|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
OP
|
$27.58
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$188.05 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.05
|
| Rate for Payer: Blue Shield of California Commercial |
$18.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.19
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cigna of CA HMO |
$17.65
|
| Rate for Payer: Cigna of CA PPO |
$20.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.70
|
| Rate for Payer: EPIC Health Plan Senior |
$19.04
|
| Rate for Payer: Galaxy Health WC |
$23.44
|
| Rate for Payer: Global Benefits Group Commercial |
$16.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$22.06
|
| Rate for Payer: Networks By Design Commercial |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$23.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
IP
|
$22.42
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$19.06 |
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Senior |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.06
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: Prime Health Services Commercial |
$19.06
|
|
|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
OP
|
$22.42
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.94
|
| Rate for Payer: Blue Shield of California Commercial |
$15.00
|
| Rate for Payer: Blue Shield of California EPN |
$9.91
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$16.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$19.06
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$17.94
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: Prime Health Services Commercial |
$19.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
OP
|
$39.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$26.59
|
| Rate for Payer: Blue Shield of California EPN |
$17.57
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Cigna of CA HMO |
$25.44
|
| Rate for Payer: Cigna of CA PPO |
$29.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$33.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$31.80
|
| Rate for Payer: Networks By Design Commercial |
$25.84
|
| Rate for Payer: Prime Health Services Commercial |
$33.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
IP
|
$39.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$33.79 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.90
|
| Rate for Payer: Galaxy Health WC |
$33.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: Multiplan Commercial |
$31.80
|
| Rate for Payer: Networks By Design Commercial |
$25.84
|
| Rate for Payer: Prime Health Services Commercial |
$33.79
|
|
|
HC SOM ACETYLCHOLINESTERASE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
