|
HC SOLVENT DETERGENT POOLED PLASM
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904771
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.98
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cigna of CA HMO |
$51.84
|
| Rate for Payer: Cigna of CA PPO |
$59.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.24
|
| Rate for Payer: EPIC Health Plan Senior |
$77.50
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$115.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.45
|
|
|
HC SOLVENT DETERGENT POOLED PLASM
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904771
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Senior |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.44
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
|
|
HC SOM 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
|
OP
|
$23.81
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$309.37 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| 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 |
$309.37
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California Commercial |
$16.60
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cigna of CA HMO |
$15.24
|
| Rate for Payer: Cigna of CA PPO |
$17.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.12
|
| Rate for Payer: EPIC Health Plan Senior |
$34.08
|
| Rate for Payer: Galaxy Health WC |
$20.24
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| 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 |
$19.05
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.29
|
| 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 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
|
IP
|
$23.81
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Adventist Health Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.52
|
| Rate for Payer: EPIC Health Plan Senior |
$9.52
|
| Rate for Payer: Galaxy Health WC |
$20.24
|
| Rate for Payer: Global Benefits Group Commercial |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$19.05
|
| Rate for Payer: Networks By Design Commercial |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$20.24
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$280.39 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.39
|
| Rate for Payer: Blue Shield of California Commercial |
$12.23
|
| Rate for Payer: Blue Shield of California Commercial |
$8.09
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.83
|
| Rate for Payer: EPIC Health Plan Senior |
$29.89
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.41
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
HC SOM 199PC 86301
|
Facility
|
OP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$214.65 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.65
|
| Rate for Payer: Blue Shield of California Commercial |
$13.74
|
| Rate for Payer: Blue Shield of California Commercial |
$20.78
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Cigna of CA HMO |
$19.08
|
| Rate for Payer: Cigna of CA PPO |
$22.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$25.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$23.85
|
| Rate for Payer: Networks By Design Commercial |
$19.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM 199PC 86301
|
Facility
|
IP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$25.34 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Cash Price |
$29.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Senior |
$11.92
|
| Rate for Payer: Galaxy Health WC |
$25.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$23.85
|
| Rate for Payer: Networks By Design Commercial |
$19.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.34
|
|
|
HC SOM 22FP 88271 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.34
|
| 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 22FP 88271 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$1,751.12 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| 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 |
$1,751.12
|
| Rate for Payer: Blue Shield of California Commercial |
$13.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.86
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO |
$12.30
|
| Rate for Payer: Cigna of CA PPO |
$14.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| 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 |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.53
|
| 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 22FP 88271 SINGLE
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$16.54 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: EPIC Health Plan Senior |
$7.78
|
| Rate for Payer: Galaxy Health WC |
$16.54
|
| Rate for Payer: Global Benefits Group Commercial |
$11.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.67
|
| Rate for Payer: Multiplan Commercial |
$15.57
|
| Rate for Payer: Networks By Design Commercial |
$12.65
|
| Rate for Payer: Prime Health Services Commercial |
$16.54
|
|
|
HC SOM 22FP 88271 SINGLE
|
Facility
|
OP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$1,751.12 |
| Rate for Payer: Cigna of CA PPO |
$14.40
|
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| 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 |
$1,751.12
|
| Rate for Payer: Blue Shield of California Commercial |
$13.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8.97
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cigna of CA HMO |
$12.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$16.54
|
| Rate for Payer: Global Benefits Group Commercial |
$11.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$12.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.67
|
| 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 |
$15.57
|
| Rate for Payer: Networks By Design Commercial |
$12.65
|
| Rate for Payer: Prime Health Services Commercial |
$16.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.68
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.34
|
| 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 22FP 88275 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$2,701.73 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.91
|
| 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 |
$2,701.73
|
| Rate for Payer: Blue Shield of California Commercial |
$13.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.86
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO |
$12.30
|
| Rate for Payer: Cigna of CA PPO |
$14.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| 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 |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.53
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.23
|
| 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 Foundation Hospitals Commercial/Self Funded |
$178.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.24
|
| 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 |
$2,701.73 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.91
|
| 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 |
$2,701.73
|
| Rate for Payer: Blue Shield of California Commercial |
$129.89
|
| Rate for Payer: Blue Shield of California Commercial |
$196.39
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$239.50
|
| Rate for Payer: Global Benefits Group Commercial |
$169.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$178.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$324.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$294.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$273.25
|
| 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 |
$1,751.12 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| 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 |
$1,751.12
|
| Rate for Payer: Blue Shield of California Commercial |
$213.51
|
| Rate for Payer: Blue Shield of California Commercial |
$322.81
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$324.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$393.67
|
| Rate for Payer: Global Benefits Group Commercial |
$277.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$294.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| 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 |
$2,701.73 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.91
|
| 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 |
$2,701.73
|
| Rate for Payer: Blue Shield of California Commercial |
$139.52
|
| Rate for Payer: Blue Shield of California Commercial |
$210.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$257.24
|
| Rate for Payer: Global Benefits Group Commercial |
$181.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$192.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.85
|
| 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 Foundation Hospitals Commercial/Self Funded |
$192.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.56
|
| 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
|
OP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,751.12 |
| Rate for Payer: Cigna of CA PPO |
$368.19
|
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| 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 |
$1,751.12
|
| Rate for Payer: Blue Shield of California Commercial |
$229.38
|
| Rate for Payer: Blue Shield of California Commercial |
$346.80
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$348.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$422.93
|
| Rate for Payer: Global Benefits Group Commercial |
$298.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$315.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$348.29
|
| 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 Foundation Hospitals Commercial/Self Funded |
$315.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$293.56
|
| 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 5-FLUOROCYTOSINE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| 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 |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California Commercial |
$28.58
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| 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 |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| 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 5-FLUOROCYTOSINE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC SOM 7-DEHYDROCHOLESTERL
|
Facility
|
OP
|
$84.56
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$16.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| 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 |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$38.98
|
| Rate for Payer: Blue Shield of California Commercial |
$58.94
|
| Rate for Payer: Cash Price |
$84.56
|
| Rate for Payer: Cash Price |
$84.56
|
| Rate for Payer: Cigna of CA HMO |
$54.12
|
| Rate for Payer: Cigna of CA PPO |
$62.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$71.88
|
| Rate for Payer: Global Benefits Group Commercial |
$50.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$53.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.29
|
| 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 |
$67.65
|
| Rate for Payer: Networks By Design Commercial |
$54.96
|
| Rate for Payer: Prime Health Services Commercial |
$71.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.74
|
| 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
|
|
