|
HC SOM C. PSITTACI IGM
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$127.47 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$6.62
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.12
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$8.28
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$8.28
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$84.72 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.72
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.66
|
| Rate for Payer: EPIC Health Plan Senior |
$13.82
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.20
|
| Rate for Payer: United Healthcare All Other HMO |
$11.20
|
| Rate for Payer: United Healthcare HMO Rider |
$11.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$5.79
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$5.54
|
| Rate for Payer: Cigna of CA PPO |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.78
|
| Rate for Payer: Galaxy Health WC |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$6.93
|
| Rate for Payer: Networks By Design Commercial |
$5.63
|
| Rate for Payer: Prime Health Services Commercial |
$7.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
IP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Senior |
$3.46
|
| Rate for Payer: Galaxy Health WC |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.08
|
| Rate for Payer: Multiplan Commercial |
$6.93
|
| Rate for Payer: Networks By Design Commercial |
$5.63
|
| Rate for Payer: Prime Health Services Commercial |
$7.36
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$4.41
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$48.94 |
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.95
|
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.94
|
| Rate for Payer: Blue Shield of California Commercial |
$3.69
|
| Rate for Payer: Blue Shield of California EPN |
$2.44
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$4.41
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$8.28
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
|
|
HC SOM CSF IGG INDEX IGG, S
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cigna of CA HMO |
$6.62
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Senior |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$8.28
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
IP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$16.44
|
| Rate for Payer: Global Benefits Group Commercial |
$11.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$15.47
|
| Rate for Payer: Networks By Design Commercial |
$12.57
|
| Rate for Payer: Prime Health Services Commercial |
$16.44
|
|
|
HC SOM C-TELOPEPTIDE
|
Facility
|
OP
|
$19.34
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912783
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$272.17 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.17
|
| Rate for Payer: Blue Shield of California Commercial |
$12.94
|
| Rate for Payer: Blue Shield of California EPN |
$8.55
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cigna of CA HMO |
$12.38
|
| Rate for Payer: Cigna of CA PPO |
$14.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.22
|
| Rate for Payer: EPIC Health Plan Senior |
$18.68
|
| Rate for Payer: Galaxy Health WC |
$16.44
|
| Rate for Payer: Global Benefits Group Commercial |
$11.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.03
|
| Rate for Payer: Multiplan Commercial |
$15.47
|
| Rate for Payer: Networks By Design Commercial |
$12.57
|
| Rate for Payer: Prime Health Services Commercial |
$16.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.13
|
| Rate for Payer: United Healthcare All Other HMO |
$15.13
|
| Rate for Payer: United Healthcare HMO Rider |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM C. TRACHOMATIS, IGG
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
|
|
HC SOM C. TRACHOMATIS, IGG
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$127.47 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4.68
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.96
|
| Rate for Payer: EPIC Health Plan Senior |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO |
$9.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. TRACHOMATIS IGM
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.95 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
|
|
HC SOM C. TRACHOMATIS IGM
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$127.47 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4.68
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$5.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.12
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$5.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.55
|
| Rate for Payer: Prime Health Services Commercial |
$5.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM CUCRU 82525
|
Facility
|
IP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.59
|
| Rate for Payer: Multiplan Commercial |
$68.64
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
|
|
HC SOM CUCRU 82525
|
Facility
|
OP
|
$85.80
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900914747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$122.89 |
| Rate for Payer: EPIC Health Plan Senior |
$12.41
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.89
|
| Rate for Payer: Blue Shield of California Commercial |
$57.40
|
| Rate for Payer: Blue Shield of California EPN |
$37.92
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna of CA HMO |
$54.91
|
| Rate for Payer: Cigna of CA PPO |
$63.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$68.64
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM CULTURE 05
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.00
|
| Rate for Payer: Blue Shield of California Commercial |
$117.08
|
| Rate for Payer: Blue Shield of California EPN |
$77.35
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CULTURE 05
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915288
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM CYANIDE
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 82600
|
| Hospital Charge Code |
900911136
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$191.64 |
| Rate for Payer: Adventist Health Commercial |
$17.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.64
|
| Rate for Payer: Blue Shield of California Commercial |
$59.54
|
| Rate for Payer: Blue Shield of California EPN |
$39.34
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cigna of CA HMO |
$56.96
|
| Rate for Payer: Cigna of CA PPO |
$65.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.19
|
| Rate for Payer: EPIC Health Plan Senior |
$19.40
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.71
|
| Rate for Payer: United Healthcare All Other HMO |
$15.71
|
| Rate for Payer: United Healthcare HMO Rider |
$15.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.34
|
| Rate for Payer: Vantage Medical Group Senior |
$19.40
|
|
