|
HC SOM BORON
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900914503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$62.05 |
| Rate for Payer: Adventist Health Commercial |
$14.60
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: EPIC Health Plan Senior |
$29.20
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| 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
|
|
|
HC SOM BORRELIA BURGDORFERI PCR DETECT
|
Facility
|
OP
|
$26.67
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| 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 |
$12.29
|
| Rate for Payer: Blue Shield of California Commercial |
$18.59
|
| Rate for Payer: Cash Price |
$26.67
|
| Rate for Payer: Cash Price |
$26.67
|
| Rate for Payer: Cigna of CA HMO |
$17.07
|
| Rate for Payer: Cigna of CA PPO |
$19.74
|
| 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 |
$18.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$22.67
|
| Rate for Payer: Global Benefits Group Commercial |
$16.00
|
| 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 |
$16.94
|
| 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 |
$6.40
|
| 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 |
$21.34
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Prime Health Services Commercial |
$22.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.00
|
| 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 BORRELIA BURGDORFERI PCR DETECT
|
Facility
|
IP
|
$26.67
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$22.67 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Cash Price |
$26.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.67
|
| Rate for Payer: EPIC Health Plan Senior |
$10.67
|
| Rate for Payer: Galaxy Health WC |
$22.67
|
| Rate for Payer: Global Benefits Group Commercial |
$16.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$21.34
|
| Rate for Payer: Networks By Design Commercial |
$17.34
|
| Rate for Payer: Prime Health Services Commercial |
$22.67
|
|
|
HC SOM BORRELIA BURGDORFERI PCR PROBE
|
Facility
|
IP
|
$26.66
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
900912513
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$22.66 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.66
|
| Rate for Payer: EPIC Health Plan Senior |
$10.66
|
| Rate for Payer: Galaxy Health WC |
$22.66
|
| Rate for Payer: Global Benefits Group Commercial |
$16.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$21.33
|
| Rate for Payer: Networks By Design Commercial |
$17.33
|
| Rate for Payer: Prime Health Services Commercial |
$22.66
|
|
|
HC SOM BORRELIA BURGDORFERI PCR PROBE
|
Facility
|
OP
|
$26.66
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
900912513
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$5.33
|
| 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 |
$12.29
|
| Rate for Payer: Blue Shield of California Commercial |
$18.58
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Cigna of CA HMO |
$17.06
|
| Rate for Payer: Cigna of CA PPO |
$19.73
|
| 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 |
$18.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$22.66
|
| Rate for Payer: Global Benefits Group Commercial |
$16.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| 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 |
$21.33
|
| Rate for Payer: Networks By Design Commercial |
$17.33
|
| Rate for Payer: Prime Health Services Commercial |
$22.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.00
|
| 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 BPAB IMMUNOASSAY NONANTIBODY
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915527
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25.00
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$50.00
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
|
|
HC SOM BPAB IMMUNOASSAY NONANTIBODY
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900915527
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$28.81
|
| Rate for Payer: Blue Shield of California Commercial |
$43.56
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna of CA HMO |
$40.00
|
| Rate for Payer: Cigna of CA PPO |
$46.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$50.00
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM BRUCELLA AB CONFIRMATION
|
Facility
|
IP
|
$21.06
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$17.90 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.42
|
| Rate for Payer: EPIC Health Plan Senior |
$8.42
|
| Rate for Payer: Galaxy Health WC |
$17.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$13.69
|
| Rate for Payer: Prime Health Services Commercial |
$17.90
|
|
|
HC SOM BRUCELLA AB CONFIRMATION
|
Facility
|
OP
|
$21.06
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Adventist Health Commercial |
$4.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.25
|
| Rate for Payer: Blue Shield of California Commercial |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cigna of CA HMO |
$13.48
|
| Rate for Payer: Cigna of CA PPO |
$15.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.73
|
| Rate for Payer: EPIC Health Plan Senior |
$9.82
|
| Rate for Payer: Galaxy Health WC |
$17.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$13.69
|
| Rate for Payer: Prime Health Services Commercial |
$17.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO |
$7.24
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB IGG
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900911628
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM BRUCELLA AB IGG
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900911628
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.25
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.73
|
| Rate for Payer: EPIC Health Plan Senior |
$9.82
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO |
$7.24
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB IGM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$83.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$74.25
|
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.25
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.73
|
| Rate for Payer: EPIC Health Plan Senior |
$9.82
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO |
$7.24
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB IGM
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM C-1 ESTERASE INHIBITOR ACTIVIT
|
Facility
|
IP
|
$21.92
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.77
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$18.63
|
| Rate for Payer: Global Benefits Group Commercial |
$13.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
| Rate for Payer: Networks By Design Commercial |
$14.25
|
| Rate for Payer: Prime Health Services Commercial |
$18.63
|
|
|
HC SOM C-1 ESTERASE INHIBITOR ACTIVIT
|
Facility
|
OP
|
$21.92
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$140.51 |
| Rate for Payer: Adventist Health Commercial |
$4.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.51
|
| Rate for Payer: Blue Shield of California Commercial |
$10.11
|
| Rate for Payer: Blue Shield of California Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Cigna of CA HMO |
$14.03
|
| Rate for Payer: Cigna of CA PPO |
$16.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.44
|
| Rate for Payer: EPIC Health Plan Senior |
$14.96
|
| Rate for Payer: Galaxy Health WC |
$18.63
|
| Rate for Payer: Global Benefits Group Commercial |
$13.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
| Rate for Payer: Networks By Design Commercial |
$14.25
|
| Rate for Payer: Prime Health Services Commercial |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC SOM C1 EXTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$16.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM C1 EXTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC SOM CA 27.29
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM CA 27.29
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$214.65 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.65
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM CADMIUM WHOLE BLOOD
|
Facility
|
IP
|
$21.93
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.77
|
| Rate for Payer: EPIC Health Plan Senior |
$8.77
|
| Rate for Payer: Galaxy Health WC |
$18.64
|
| Rate for Payer: Global Benefits Group Commercial |
$13.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
| Rate for Payer: Networks By Design Commercial |
$14.25
|
| Rate for Payer: Prime Health Services Commercial |
$18.64
|
|
|
HC SOM CADMIUM WHOLE BLOOD
|
Facility
|
OP
|
$21.93
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$238.76 |
| Rate for Payer: United Healthcare HMO Rider |
$19.15
|
| Rate for Payer: Adventist Health Commercial |
$4.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.76
|
| Rate for Payer: Blue Shield of California Commercial |
$10.11
|
| Rate for Payer: Blue Shield of California Commercial |
$15.29
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cigna of CA HMO |
$14.04
|
| Rate for Payer: Cigna of CA PPO |
$16.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.01
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$18.64
|
| Rate for Payer: Global Benefits Group Commercial |
$13.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$17.54
|
| Rate for Payer: Networks By Design Commercial |
$14.25
|
| Rate for Payer: Prime Health Services Commercial |
$18.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.15
|
| Rate for Payer: United Healthcare All Other HMO |
$19.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
|
IP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$65.42 |
| Rate for Payer: Galaxy Health WC |
$65.42
|
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.78
|
| Rate for Payer: EPIC Health Plan Senior |
$30.78
|
| Rate for Payer: Global Benefits Group Commercial |
$46.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.47
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Networks By Design Commercial |
$50.02
|
| Rate for Payer: Prime Health Services Commercial |
$65.42
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
|
OP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$302.07 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.07
|
| Rate for Payer: Blue Shield of California Commercial |
$35.48
|
| Rate for Payer: Blue Shield of California Commercial |
$53.64
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Cigna of CA HMO |
$49.25
|
| Rate for Payer: Cigna of CA PPO |
$56.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.21
|
| Rate for Payer: Galaxy Health WC |
$65.42
|
| Rate for Payer: Global Benefits Group Commercial |
$46.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Networks By Design Commercial |
$50.02
|
| Rate for Payer: Prime Health Services Commercial |
$65.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.71
|
| Rate for Payer: United Healthcare All Other HMO |
$23.71
|
| Rate for Payer: United Healthcare HMO Rider |
$23.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
|
IP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$60.70 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.56
|
| Rate for Payer: EPIC Health Plan Senior |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$60.70
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$57.13
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.70
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
|
OP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$280.39 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.39
|
| Rate for Payer: Blue Shield of California Commercial |
$32.92
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cigna of CA HMO |
$45.70
|
| Rate for Payer: Cigna of CA PPO |
$52.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.83
|
| Rate for Payer: EPIC Health Plan Senior |
$29.89
|
| Rate for Payer: Galaxy Health WC |
$60.70
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.41
|
| Rate for Payer: Multiplan Commercial |
$57.13
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
