|
HC SOM CAH ANDROSTENEDIONE
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900912771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$65.41 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.78
|
| Rate for Payer: EPIC Health Plan Senior |
$30.78
|
| Rate for Payer: Galaxy Health WC |
$65.41
|
| Rate for Payer: Global Benefits Group Commercial |
$46.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.47
|
| Rate for Payer: Multiplan Commercial |
$61.56
|
| Rate for Payer: Networks By Design Commercial |
$50.02
|
| Rate for Payer: Prime Health Services Commercial |
$65.41
|
|
|
HC SOM CAH CORTISOL
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$36.41 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.14
|
| Rate for Payer: EPIC Health Plan Senior |
$17.14
|
| Rate for Payer: Galaxy Health WC |
$36.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.28
|
| Rate for Payer: Multiplan Commercial |
$34.27
|
| Rate for Payer: Networks By Design Commercial |
$27.85
|
| Rate for Payer: Prime Health Services Commercial |
$36.41
|
|
|
HC SOM CAH CORTISOL
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$161.19 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.19
|
| Rate for Payer: Blue Shield of California Commercial |
$28.66
|
| Rate for Payer: Blue Shield of California EPN |
$18.94
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cigna of CA HMO |
$27.42
|
| Rate for Payer: Cigna of CA PPO |
$31.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$36.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$34.27
|
| Rate for Payer: Networks By Design Commercial |
$27.85
|
| Rate for Payer: Prime Health Services Commercial |
$36.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$249.63 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.63
|
| Rate for Payer: Blue Shield of California Commercial |
$44.43
|
| Rate for Payer: Blue Shield of California EPN |
$29.35
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Cigna of CA HMO |
$42.50
|
| Rate for Payer: Cigna of CA PPO |
$49.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Senior |
$25.27
|
| Rate for Payer: Galaxy Health WC |
$56.45
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$53.13
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.47
|
| Rate for Payer: United Healthcare All Other HMO |
$20.47
|
| Rate for Payer: United Healthcare HMO Rider |
$20.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.56
|
| Rate for Payer: EPIC Health Plan Senior |
$26.56
|
| Rate for Payer: Galaxy Health WC |
$56.45
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.94
|
| Rate for Payer: Multiplan Commercial |
$53.13
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.45
|
|
|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
|
IP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$69.21 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.57
|
| Rate for Payer: EPIC Health Plan Senior |
$32.57
|
| Rate for Payer: Galaxy Health WC |
$69.21
|
| Rate for Payer: Global Benefits Group Commercial |
$48.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.54
|
| Rate for Payer: Multiplan Commercial |
$65.14
|
| Rate for Payer: Networks By Design Commercial |
$52.92
|
| Rate for Payer: Prime Health Services Commercial |
$69.21
|
|
|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
|
OP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$296.04 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.04
|
| Rate for Payer: Blue Shield of California Commercial |
$54.47
|
| Rate for Payer: Blue Shield of California EPN |
$35.99
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Cigna of CA HMO |
$52.11
|
| Rate for Payer: Cigna of CA PPO |
$60.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.82
|
| Rate for Payer: EPIC Health Plan Senior |
$30.98
|
| Rate for Payer: Galaxy Health WC |
$69.21
|
| Rate for Payer: Global Benefits Group Commercial |
$48.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$65.14
|
| Rate for Payer: Networks By Design Commercial |
$52.92
|
| Rate for Payer: Prime Health Services Commercial |
$69.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
|
OP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$206.07 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.07
|
| Rate for Payer: Blue Shield of California Commercial |
$36.68
|
| Rate for Payer: Blue Shield of California EPN |
$24.23
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Cigna of CA HMO |
$35.09
|
| Rate for Payer: Cigna of CA PPO |
$40.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.16
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$46.61
|
| Rate for Payer: Global Benefits Group Commercial |
$32.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$43.86
|
| Rate for Payer: Networks By Design Commercial |
$35.64
|
| Rate for Payer: Prime Health Services Commercial |
$46.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other HMO |
$16.89
|
| Rate for Payer: United Healthcare HMO Rider |
$16.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
|
IP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$46.61 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.93
|
| Rate for Payer: Galaxy Health WC |
$46.61
|
| Rate for Payer: Global Benefits Group Commercial |
$32.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.16
|
| Rate for Payer: Multiplan Commercial |
$43.86
|
| Rate for Payer: Networks By Design Commercial |
$35.64
|
| Rate for Payer: Prime Health Services Commercial |
$46.61
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
IP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$57.66 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.13
|
| Rate for Payer: EPIC Health Plan Senior |
$27.13
|
| Rate for Payer: Galaxy Health WC |
$57.66
|
| Rate for Payer: Global Benefits Group Commercial |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.28
|
| Rate for Payer: Multiplan Commercial |
$54.26
|
| Rate for Payer: Networks By Design Commercial |
$44.09
|
| Rate for Payer: Prime Health Services Commercial |
$57.66
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
OP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$254.95 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.95
|
| Rate for Payer: Blue Shield of California Commercial |
$45.38
|
| Rate for Payer: Blue Shield of California EPN |
$29.98
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Cigna of CA HMO |
$43.41
|
| Rate for Payer: Cigna of CA PPO |
$50.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$57.66
|
| Rate for Payer: Global Benefits Group Commercial |
$40.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$54.26
|
| Rate for Payer: Networks By Design Commercial |
$44.09
|
| Rate for Payer: Prime Health Services Commercial |
$57.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM CALCITONIN
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM CALCITONIN
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$264.53 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.53
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.17
|
| Rate for Payer: EPIC Health Plan Senior |
$26.79
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.90
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.70
|
| Rate for Payer: United Healthcare All Other HMO |
$21.70
|
| Rate for Payer: United Healthcare HMO Rider |
$21.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$26.79
|
|
|
HC SOM CALPROTECTIN
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$193.84 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.84
|
| Rate for Payer: Blue Shield of California Commercial |
$60.21
|
| Rate for Payer: Blue Shield of California EPN |
$39.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.30
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.90
|
| Rate for Payer: United Healthcare All Other HMO |
$15.90
|
| Rate for Payer: United Healthcare HMO Rider |
$15.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Vantage Medical Group Senior |
$19.63
|
|
|
HC SOM CALPROTECTIN
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC SOM CANDIDA AURIS SURV PCR
|
Facility
|
IP
|
$494.90
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900915483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$420.67 |
| Rate for Payer: Adventist Health Commercial |
$98.98
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.96
|
| Rate for Payer: EPIC Health Plan Senior |
$197.96
|
| Rate for Payer: Galaxy Health WC |
$420.67
|
| Rate for Payer: Global Benefits Group Commercial |
$296.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.78
|
| Rate for Payer: Multiplan Commercial |
$395.92
|
| Rate for Payer: Networks By Design Commercial |
$321.69
|
| Rate for Payer: Prime Health Services Commercial |
$420.67
|
|
|
HC SOM CANDIDA AURIS SURV PCR
|
Facility
|
OP
|
$494.90
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900915483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$420.67 |
| Rate for Payer: Adventist Health Commercial |
$98.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$331.09
|
| Rate for Payer: Blue Shield of California EPN |
$218.75
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: Cash Price |
$494.90
|
| Rate for Payer: Cigna of CA HMO |
$316.74
|
| Rate for Payer: Cigna of CA PPO |
$366.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$420.67
|
| Rate for Payer: Global Benefits Group Commercial |
$296.94
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$395.92
|
| Rate for Payer: Networks By Design Commercial |
$321.69
|
| Rate for Payer: Prime Health Services Commercial |
$420.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$296.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$296.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.46
|
| Rate for Payer: Blue Shield of California Commercial |
$110.18
|
| Rate for Payer: Blue Shield of California EPN |
$72.80
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna of CA HMO |
$105.41
|
| Rate for Payer: Cigna of CA PPO |
$121.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$98.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$131.76
|
| Rate for Payer: Networks By Design Commercial |
$107.06
|
| Rate for Payer: Prime Health Services Commercial |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Galaxy Health WC |
$140.00
|
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.88
|
| Rate for Payer: EPIC Health Plan Senior |
$65.88
|
| Rate for Payer: Global Benefits Group Commercial |
$98.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.53
|
| Rate for Payer: Multiplan Commercial |
$131.76
|
| Rate for Payer: Networks By Design Commercial |
$107.06
|
| Rate for Payer: Prime Health Services Commercial |
$140.00
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.09
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.38
|
| Rate for Payer: EPIC Health Plan Senior |
$18.06
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
IP
|
$354.50
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$301.32 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.80
|
| Rate for Payer: EPIC Health Plan Senior |
$141.80
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.08
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
OP
|
$354.50
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$301.32 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.09
|
| Rate for Payer: Blue Shield of California Commercial |
$237.16
|
| Rate for Payer: Blue Shield of California EPN |
$156.69
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cigna of CA HMO |
$226.88
|
| Rate for Payer: Cigna of CA PPO |
$262.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.38
|
| Rate for Payer: EPIC Health Plan Senior |
$18.06
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$121.76 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.76
|
| Rate for Payer: Blue Shield of California Commercial |
$23.41
|
| Rate for Payer: Blue Shield of California EPN |
$15.47
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.63
|
| Rate for Payer: EPIC Health Plan Senior |
$12.32
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Other HMO |
$9.98
|
| Rate for Payer: United Healthcare HMO Rider |
$9.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.32
|
|
