|
HC SOM FACTOR IX INH. SCREEN
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM FACTOR VIII BETHESDA UNITS
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.14
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM FACTOR VIII BETHESDA UNITS
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM FACTOR VIII INHIB PROF INTERP
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.94
|
| Rate for Payer: Blue Shield of California Commercial |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$33.15
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM FACTOR VIII INHIB PROF INTERP
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM FACTOR VIII INH. SCREEN
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900912803
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM FACTOR VIII INH. SCREEN
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900912803
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.14
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$55.25
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM FANBF 86038
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900914925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM FANBF 86038
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900914925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$119.36 |
| Rate for Payer: EPIC Health Plan Senior |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.36
|
| Rate for Payer: Blue Shield of California Commercial |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$33.15
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC SOM FAP KNOWN MUT EXTRACT
|
Facility
|
OP
|
$318.21
|
|
|
Service Code
|
CPT 81202
|
| Hospital Charge Code |
900914620
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: EPIC Health Plan Senior |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$270.48
|
| Rate for Payer: Adventist Health Commercial |
$63.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$420.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.40
|
| Rate for Payer: Blue Shield of California Commercial |
$212.88
|
| Rate for Payer: Blue Shield of California EPN |
$140.65
|
| Rate for Payer: Cash Price |
$318.21
|
| Rate for Payer: Cash Price |
$318.21
|
| Rate for Payer: Cigna of CA HMO |
$203.65
|
| Rate for Payer: Cigna of CA PPO |
$235.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$420.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$308.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: Global Benefits Group Commercial |
$190.93
|
| Rate for Payer: Heritage Provider Network Commercial |
$459.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$254.57
|
| Rate for Payer: Networks By Design Commercial |
$206.84
|
| Rate for Payer: Prime Health Services Commercial |
$270.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.80
|
| Rate for Payer: United Healthcare All Other HMO |
$226.80
|
| Rate for Payer: United Healthcare HMO Rider |
$226.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$280.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Vantage Medical Group Senior |
$280.00
|
|
|
HC SOM FAP KNOWN MUT EXTRACT
|
Facility
|
IP
|
$318.21
|
|
|
Service Code
|
CPT 81202
|
| Hospital Charge Code |
900914620
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$270.48 |
| Rate for Payer: Adventist Health Commercial |
$63.64
|
| Rate for Payer: Cash Price |
$318.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.28
|
| Rate for Payer: EPIC Health Plan Senior |
$127.28
|
| Rate for Payer: Galaxy Health WC |
$270.48
|
| Rate for Payer: Global Benefits Group Commercial |
$190.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.37
|
| Rate for Payer: Multiplan Commercial |
$254.57
|
| Rate for Payer: Networks By Design Commercial |
$206.84
|
| Rate for Payer: Prime Health Services Commercial |
$270.48
|
|
|
HC SOM FASP 86606
|
Facility
|
OP
|
$77.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$148.69 |
| Rate for Payer: Adventist Health Commercial |
$15.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.03
|
| 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 |
$148.69
|
| Rate for Payer: Blue Shield of California Commercial |
$52.05
|
| Rate for Payer: Blue Shield of California EPN |
$34.39
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cigna of CA HMO |
$49.79
|
| Rate for Payer: Cigna of CA PPO |
$57.57
|
| 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: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$66.13
|
| Rate for Payer: Global Benefits Group Commercial |
$46.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.67
|
| 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 |
$62.24
|
| Rate for Payer: Networks By Design Commercial |
$50.57
|
| Rate for Payer: Prime Health Services Commercial |
$66.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.68
|
| 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 FASP 86606
|
Facility
|
IP
|
$77.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$66.13 |
| Rate for Payer: Adventist Health Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.12
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$66.13
|
| Rate for Payer: Global Benefits Group Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.67
|
| Rate for Payer: Multiplan Commercial |
$62.24
|
| Rate for Payer: Networks By Design Commercial |
$50.57
|
| Rate for Payer: Prime Health Services Commercial |
$66.13
|
|
|
HC SOM FAT FECAL QUANT
|
Facility
|
OP
|
$28.02
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
900911139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.98
|
| Rate for Payer: Blue Shield of California Commercial |
$18.75
|
| Rate for Payer: Blue Shield of California EPN |
$12.38
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cigna of CA HMO |
$17.93
|
| Rate for Payer: Cigna of CA PPO |
$20.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$23.82
|
| Rate for Payer: Global Benefits Group Commercial |
$16.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Networks By Design Commercial |
$18.21
|
| Rate for Payer: Prime Health Services Commercial |
$23.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC SOM FAT FECAL QUANT
|
Facility
|
IP
|
$28.02
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
900911139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Senior |
$11.21
|
| Rate for Payer: Galaxy Health WC |
$23.82
|
| Rate for Payer: Global Benefits Group Commercial |
$16.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Networks By Design Commercial |
$18.21
|
| Rate for Payer: Prime Health Services Commercial |
$23.82
|
|
|
HC SOM FATTY ACIDS FREE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900910286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM FATTY ACIDS FREE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900910286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.53
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: EPIC Health Plan Senior |
$18.77
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.20
|
| Rate for Payer: United Healthcare All Other HMO |
$15.20
|
| Rate for Payer: United Healthcare HMO Rider |
$15.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.77
|
|
|
HC SOM FATTY ACIDS PEROXISOMAL
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
900911471
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Blue Shield of California EPN |
$66.30
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.66
|
| Rate for Payer: EPIC Health Plan Senior |
$19.75
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.46
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.73
|
| Rate for Payer: Vantage Medical Group Senior |
$19.75
|
|
|
HC SOM FATTY ACIDS PEROXISOMAL
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
900911471
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM FBIOT 84591
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
900914760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.44
|
| Rate for Payer: Blue Shield of California Commercial |
$66.90
|
| Rate for Payer: Blue Shield of California EPN |
$44.20
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.03
|
| Rate for Payer: EPIC Health Plan Senior |
$17.06
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.81
|
| Rate for Payer: United Healthcare All Other HMO |
$13.81
|
| Rate for Payer: United Healthcare HMO Rider |
$13.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.77
|
| Rate for Payer: Vantage Medical Group Senior |
$17.06
|
|
|
HC SOM FBIOT 84591
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
900914760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM FBP1 88273
|
Facility
|
OP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$1,876.81 |
| Rate for Payer: Adventist Health Commercial |
$16.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,876.81
|
| Rate for Payer: Blue Shield of California Commercial |
$56.77
|
| Rate for Payer: Blue Shield of California EPN |
$37.51
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cigna of CA HMO |
$54.31
|
| Rate for Payer: Cigna of CA PPO |
$62.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Senior |
$34.81
|
| Rate for Payer: Galaxy Health WC |
$72.13
|
| Rate for Payer: Global Benefits Group Commercial |
$50.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: Networks By Design Commercial |
$55.16
|
| Rate for Payer: Prime Health Services Commercial |
$72.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM FBP1 88273
|
Facility
|
IP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$72.13 |
| Rate for Payer: EPIC Health Plan Senior |
$33.94
|
| Rate for Payer: Galaxy Health WC |
$72.13
|
| Rate for Payer: Adventist Health Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.94
|
| Rate for Payer: Global Benefits Group Commercial |
$50.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: Networks By Design Commercial |
$55.16
|
| Rate for Payer: Prime Health Services Commercial |
$72.13
|
|
|
HC SOM FBP1 88291
|
Facility
|
OP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$47.60
|
| Rate for Payer: Blue Shield of California EPN |
$31.45
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cigna of CA HMO |
$45.54
|
| Rate for Payer: Cigna of CA PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$56.92
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.48
|
| Rate for Payer: Vantage Medical Group Senior |
$60.48
|
|
|
HC SOM FBP1 88291
|
Facility
|
IP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.08
|
| Rate for Payer: Multiplan Commercial |
$56.92
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
|
