|
HC SOM BETA GLYCOPROTEIN AB IGM
|
Facility
|
OP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$262.46 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.46
|
| Rate for Payer: Blue Shield of California Commercial |
$16.61
|
| Rate for Payer: Blue Shield of California Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna of CA HMO |
$23.05
|
| Rate for Payer: Cigna of CA PPO |
$26.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$28.82
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM BETA GLYCOPROTEIN AB IGM
|
Facility
|
IP
|
$36.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
900912616
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.41
|
| Rate for Payer: EPIC Health Plan Senior |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$30.62
|
| Rate for Payer: Global Benefits Group Commercial |
$21.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.82
|
| Rate for Payer: Networks By Design Commercial |
$23.41
|
| Rate for Payer: Prime Health Services Commercial |
$30.62
|
|
|
HC SOM BETA HCG CSF
|
Facility
|
IP
|
$43.10
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$36.63 |
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.24
|
| Rate for Payer: EPIC Health Plan Senior |
$17.24
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: Global Benefits Group Commercial |
$25.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.34
|
| Rate for Payer: Multiplan Commercial |
$34.48
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
|
|
HC SOM BETA HCG CSF
|
Facility
|
OP
|
$43.10
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900910726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$148.71 |
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$36.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: Adventist Health Commercial |
$8.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.71
|
| Rate for Payer: Blue Shield of California Commercial |
$19.87
|
| Rate for Payer: Blue Shield of California Commercial |
$30.04
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Cash Price |
$43.10
|
| Rate for Payer: Cigna of CA HMO |
$27.58
|
| Rate for Payer: Cigna of CA PPO |
$31.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.17
|
| Rate for Payer: Global Benefits Group Commercial |
$25.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$34.48
|
| Rate for Payer: Networks By Design Commercial |
$28.02
|
| Rate for Payer: Prime Health Services Commercial |
$36.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM BICARBONATE URINE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$39.65
|
| Rate for Payer: Blue Shield of California Commercial |
$59.94
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.37
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.54
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3.95
|
| Rate for Payer: United Healthcare HMO Rider |
$3.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC SOM BICARBONATE URINE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
900910363
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC SOM BILE ACIDS TOTAL
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$178.52 |
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.52
|
| Rate for Payer: Blue Shield of California Commercial |
$12.91
|
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.25
|
| Rate for Payer: EPIC Health Plan Senior |
$18.83
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.94
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.87
|
| Rate for Payer: United Healthcare All Other HMO |
$13.87
|
| Rate for Payer: United Healthcare HMO Rider |
$13.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.83
|
| Rate for Payer: Vantage Medical Group Senior |
$17.12
|
|
|
HC SOM BILE ACIDS TOTAL
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82239
|
| Hospital Charge Code |
900911123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
|
|
HC SOM BK VIRUS DNA QUANT PCR
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM BK VIRUS DNA QUANT PCR
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900912559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$27.66
|
| Rate for Payer: Blue Shield of California Commercial |
$41.82
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM BLASTOMYCES AB EIA
|
Facility
|
OP
|
$43.94
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900915370
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$20.26
|
| Rate for Payer: Blue Shield of California Commercial |
$30.63
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Cigna of CA HMO |
$28.12
|
| Rate for Payer: Cigna of CA PPO |
$32.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: Galaxy Health WC |
$37.35
|
| Rate for Payer: Global Benefits Group Commercial |
$26.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$35.15
|
| Rate for Payer: Networks By Design Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$37.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM BLASTOMYCES AB EIA
|
Facility
|
IP
|
$43.94
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900915370
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$37.35 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Cash Price |
$43.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.58
|
| Rate for Payer: EPIC Health Plan Senior |
$17.58
|
| Rate for Payer: Galaxy Health WC |
$37.35
|
| Rate for Payer: Global Benefits Group Commercial |
$26.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$35.15
|
| Rate for Payer: Networks By Design Commercial |
$28.56
|
| Rate for Payer: Prime Health Services Commercial |
$37.35
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$136.13 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.13
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.19
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
|
HC SOM BLASTOMYCES AB IMMUNODIFFUSION
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
900912686
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM BLOOM CULTURE 01
|
Facility
|
IP
|
$937.09
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$187.42 |
| Max. Negotiated Rate |
$796.53 |
| Rate for Payer: Adventist Health Commercial |
$187.42
|
| Rate for Payer: Cash Price |
$937.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$655.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$374.84
|
| Rate for Payer: EPIC Health Plan Senior |
$374.84
|
| Rate for Payer: Galaxy Health WC |
$796.53
|
| Rate for Payer: Global Benefits Group Commercial |
$562.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$595.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.90
|
| Rate for Payer: Multiplan Commercial |
$749.67
|
| Rate for Payer: Networks By Design Commercial |
$609.11
|
| Rate for Payer: Prime Health Services Commercial |
$796.53
|
|
|
HC SOM BLOOM CULTURE 01
|
Facility
|
OP
|
$937.09
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915282
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$1,020.86 |
| Rate for Payer: Adventist Health Commercial |
$187.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$968.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,020.86
|
| Rate for Payer: Blue Shield of California Commercial |
$432.00
|
| Rate for Payer: Blue Shield of California Commercial |
$653.15
|
| Rate for Payer: Cash Price |
$937.09
|
| Rate for Payer: Cash Price |
$937.09
|
| Rate for Payer: Cigna of CA HMO |
$599.74
|
| Rate for Payer: Cigna of CA PPO |
$693.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$655.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.21
|
| Rate for Payer: EPIC Health Plan Senior |
$128.14
|
| Rate for Payer: Galaxy Health WC |
$796.53
|
| Rate for Payer: Global Benefits Group Commercial |
$562.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$595.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$749.67
|
| Rate for Payer: Networks By Design Commercial |
$609.11
|
| Rate for Payer: Prime Health Services Commercial |
$796.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$562.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$562.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC SOM BNP 83880
|
Facility
|
OP
|
$170.78
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900914724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$350.43 |
| Rate for Payer: Adventist Health Commercial |
$34.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$282.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.43
|
| Rate for Payer: Blue Shield of California Commercial |
$119.03
|
| Rate for Payer: Blue Shield of California Commercial |
$78.73
|
| Rate for Payer: Cash Price |
$170.78
|
| Rate for Payer: Cash Price |
$170.78
|
| Rate for Payer: Cigna of CA HMO |
$109.30
|
| Rate for Payer: Cigna of CA PPO |
$126.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.78
|
| Rate for Payer: EPIC Health Plan Senior |
$43.19
|
| Rate for Payer: Galaxy Health WC |
$145.16
|
| Rate for Payer: Global Benefits Group Commercial |
$102.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$64.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$136.62
|
| Rate for Payer: Networks By Design Commercial |
$111.01
|
| Rate for Payer: Prime Health Services Commercial |
$145.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.80
|
| Rate for Payer: United Healthcare All Other HMO |
$31.80
|
| Rate for Payer: United Healthcare HMO Rider |
$31.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$39.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Vantage Medical Group Senior |
$39.26
|
|
|
HC SOM BNP 83880
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900914724
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$145.16 |
| Rate for Payer: Adventist Health Commercial |
$34.16
|
| Rate for Payer: Cash Price |
$170.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.31
|
| Rate for Payer: EPIC Health Plan Senior |
$68.31
|
| Rate for Payer: Galaxy Health WC |
$145.16
|
| Rate for Payer: Global Benefits Group Commercial |
$102.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.99
|
| Rate for Payer: Multiplan Commercial |
$136.62
|
| Rate for Payer: Networks By Design Commercial |
$111.01
|
| Rate for Payer: Prime Health Services Commercial |
$145.16
|
|
|
HC SOM BONE ALKALINE PHOSPHATASE
|
Facility
|
OP
|
$26.50
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900915326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$152.67 |
| Rate for Payer: Cigna of CA PPO |
$19.61
|
| Rate for Payer: Adventist Health Commercial |
$5.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.67
|
| Rate for Payer: Blue Shield of California Commercial |
$12.22
|
| Rate for Payer: Blue Shield of California Commercial |
$18.47
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna of CA HMO |
$16.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.39
|
| Rate for Payer: EPIC Health Plan Senior |
$16.26
|
| Rate for Payer: Galaxy Health WC |
$22.52
|
| Rate for Payer: Global Benefits Group Commercial |
$15.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$21.20
|
| Rate for Payer: Networks By Design Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14.78
|
|
|
HC SOM BONE ALKALINE PHOSPHATASE
|
Facility
|
IP
|
$26.50
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
900915326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$22.52 |
| Rate for Payer: Adventist Health Commercial |
$5.30
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.60
|
| Rate for Payer: EPIC Health Plan Senior |
$10.60
|
| Rate for Payer: Galaxy Health WC |
$22.52
|
| Rate for Payer: Global Benefits Group Commercial |
$15.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$21.20
|
| Rate for Payer: Networks By Design Commercial |
$17.23
|
| Rate for Payer: Prime Health Services Commercial |
$22.52
|
|
|
HC SOM BORDETELLA PCR
|
Facility
|
IP
|
$38.80
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Networks By Design Commercial |
$25.22
|
| Rate for Payer: Adventist Health Commercial |
$7.76
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.52
|
| Rate for Payer: EPIC Health Plan Senior |
$15.52
|
| Rate for Payer: Galaxy Health WC |
$32.98
|
| Rate for Payer: Global Benefits Group Commercial |
$23.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.31
|
| Rate for Payer: Multiplan Commercial |
$31.04
|
| Rate for Payer: Prime Health Services Commercial |
$32.98
|
|
|
HC SOM BORDETELLA PCR
|
Facility
|
OP
|
$38.80
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914165
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$7.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$17.89
|
| Rate for Payer: Blue Shield of California Commercial |
$27.04
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cigna of CA HMO |
$24.83
|
| Rate for Payer: Cigna of CA PPO |
$28.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$32.98
|
| Rate for Payer: Global Benefits Group Commercial |
$23.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$31.04
|
| Rate for Payer: Networks By Design Commercial |
$25.22
|
| Rate for Payer: Prime Health Services Commercial |
$32.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM BORIC ACID
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$192.35 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.35
|
| Rate for Payer: Blue Shield of California Commercial |
$40.57
|
| Rate for Payer: Blue Shield of California Commercial |
$61.34
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.23
|
| Rate for Payer: EPIC Health Plan Senior |
$24.16
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.78
|
| Rate for Payer: United Healthcare All Other HMO |
$17.78
|
| Rate for Payer: United Healthcare HMO Rider |
$17.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM BORIC ACID
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC SOM BORON
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900914503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$192.35 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.35
|
| Rate for Payer: Blue Shield of California Commercial |
$33.65
|
| Rate for Payer: Blue Shield of California Commercial |
$50.88
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.23
|
| Rate for Payer: EPIC Health Plan Senior |
$24.16
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.78
|
| Rate for Payer: United Healthcare All Other HMO |
$17.78
|
| Rate for Payer: United Healthcare HMO Rider |
$17.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
