|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
IP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$42.44 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.97
|
| Rate for Payer: EPIC Health Plan Senior |
$19.97
|
| Rate for Payer: Galaxy Health WC |
$42.44
|
| Rate for Payer: Global Benefits Group Commercial |
$29.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Networks By Design Commercial |
$32.45
|
| Rate for Payer: Prime Health Services Commercial |
$42.44
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$127.23 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.23
|
| Rate for Payer: Blue Shield of California Commercial |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$76.67
|
| 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 |
$18.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.33
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.51
|
| 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 |
$9.98
|
| Rate for Payer: United Healthcare All Other HMO |
$9.98
|
| Rate for Payer: United Healthcare HMO Rider |
$9.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.32
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| 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 CARBOXY-THC CONFIRMATION, U
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900915422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM CARBOXY-THC CONFIRMATION, U
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900915422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$234.53 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.53
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$24.39
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC SOM CARNITINE PLASMA
|
Facility
|
IP
|
$29.01
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$24.66 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.66
|
| Rate for Payer: Global Benefits Group Commercial |
$17.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$23.21
|
| Rate for Payer: Networks By Design Commercial |
$18.86
|
| Rate for Payer: Prime Health Services Commercial |
$24.66
|
|
|
HC SOM CARNITINE PLASMA
|
Facility
|
OP
|
$29.01
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$173.31 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.31
|
| Rate for Payer: Blue Shield of California Commercial |
$13.37
|
| Rate for Payer: Blue Shield of California Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Cigna of CA HMO |
$18.57
|
| Rate for Payer: Cigna of CA PPO |
$21.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$24.66
|
| Rate for Payer: Global Benefits Group Commercial |
$17.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$23.21
|
| Rate for Payer: Networks By Design Commercial |
$18.86
|
| Rate for Payer: Prime Health Services Commercial |
$24.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM CARNITINE URINE
|
Facility
|
OP
|
$60.59
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900910730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$173.31 |
| Rate for Payer: Adventist Health Commercial |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.31
|
| Rate for Payer: Blue Shield of California Commercial |
$27.93
|
| Rate for Payer: Blue Shield of California Commercial |
$42.23
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cigna of CA HMO |
$38.78
|
| Rate for Payer: Cigna of CA PPO |
$44.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$51.50
|
| Rate for Payer: Global Benefits Group Commercial |
$36.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$48.47
|
| Rate for Payer: Networks By Design Commercial |
$39.38
|
| Rate for Payer: Prime Health Services Commercial |
$51.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM CARNITINE URINE
|
Facility
|
IP
|
$60.59
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900910730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Adventist Health Commercial |
$12.12
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.24
|
| Rate for Payer: EPIC Health Plan Senior |
$24.24
|
| Rate for Payer: Galaxy Health WC |
$51.50
|
| Rate for Payer: Global Benefits Group Commercial |
$36.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.54
|
| Rate for Payer: Multiplan Commercial |
$48.47
|
| Rate for Payer: Networks By Design Commercial |
$39.38
|
| Rate for Payer: Prime Health Services Commercial |
$51.50
|
|
|
HC SOM CAROTENE
|
Facility
|
OP
|
$122.75
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
900911303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$104.34 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.27
|
| Rate for Payer: Blue Shield of California Commercial |
$56.59
|
| Rate for Payer: Blue Shield of California Commercial |
$85.56
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Cigna of CA HMO |
$78.56
|
| Rate for Payer: Cigna of CA PPO |
$90.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.21
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$104.34
|
| Rate for Payer: Global Benefits Group Commercial |
$73.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.35
|
| Rate for Payer: Multiplan Commercial |
$98.20
|
| Rate for Payer: Networks By Design Commercial |
$79.79
|
| Rate for Payer: Prime Health Services Commercial |
$104.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.47
|
| Rate for Payer: United Healthcare All Other HMO |
$7.47
|
| Rate for Payer: United Healthcare HMO Rider |
$7.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.14
|
| Rate for Payer: Vantage Medical Group Senior |
$9.22
|
|
|
HC SOM CAROTENE
|
Facility
|
IP
|
$122.75
|
|
|
Service Code
|
CPT 82380
|
| Hospital Charge Code |
900911303
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.55 |
| Max. Negotiated Rate |
$104.34 |
| Rate for Payer: Adventist Health Commercial |
$24.55
|
| Rate for Payer: Cash Price |
$122.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$85.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.10
|
| Rate for Payer: EPIC Health Plan Senior |
$49.10
|
| Rate for Payer: Galaxy Health WC |
$104.34
|
| Rate for Payer: Global Benefits Group Commercial |
$73.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$77.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.46
|
| Rate for Payer: Multiplan Commercial |
$98.20
|
| Rate for Payer: Networks By Design Commercial |
$79.79
|
| Rate for Payer: Prime Health Services Commercial |
$104.34
|
|
|
HC SOM CATECHOLAMINE FRACT FREE UR
|
Facility
|
IP
|
$33.87
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900914081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$28.79 |
| Rate for Payer: Adventist Health Commercial |
$6.77
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.55
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$28.79
|
| Rate for Payer: Global Benefits Group Commercial |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$27.10
|
| Rate for Payer: Networks By Design Commercial |
$22.02
|
| Rate for Payer: Prime Health Services Commercial |
$28.79
|
|
|
HC SOM CATECHOLAMINE FRACT FREE UR
|
Facility
|
OP
|
$33.87
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900914081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$260.65 |
| Rate for Payer: Adventist Health Commercial |
$6.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.65
|
| Rate for Payer: Blue Shield of California Commercial |
$15.61
|
| Rate for Payer: Blue Shield of California Commercial |
$23.61
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Cash Price |
$33.87
|
| Rate for Payer: Cigna of CA HMO |
$21.68
|
| Rate for Payer: Cigna of CA PPO |
$25.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Senior |
$27.77
|
| Rate for Payer: Galaxy Health WC |
$28.79
|
| Rate for Payer: Global Benefits Group Commercial |
$20.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$27.10
|
| Rate for Payer: Networks By Design Commercial |
$22.02
|
| Rate for Payer: Prime Health Services Commercial |
$28.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC SOM CATECHOLAMINES PL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM CATECHOLAMINES PL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
900910483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$260.65 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$209.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.65
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$24.39
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Senior |
$27.77
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.77
|
| Rate for Payer: Vantage Medical Group Senior |
$25.25
|
|
|
HC SOM CD4 T-CELL ABSOLUTE CT
|
Facility
|
IP
|
$31.88
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
900914709
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$27.10 |
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.75
|
| Rate for Payer: EPIC Health Plan Senior |
$12.75
|
| Rate for Payer: Galaxy Health WC |
$27.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$20.72
|
| Rate for Payer: Prime Health Services Commercial |
$27.10
|
|
|
HC SOM CD4 T-CELL ABSOLUTE CT
|
Facility
|
OP
|
$31.88
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
900914709
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$407.28 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
| Rate for Payer: Adventist Health Commercial |
$6.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$390.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.28
|
| Rate for Payer: Blue Shield of California Commercial |
$14.70
|
| Rate for Payer: Blue Shield of California Commercial |
$22.22
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cigna of CA HMO |
$20.40
|
| Rate for Payer: Cigna of CA PPO |
$23.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.52
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$27.10
|
| Rate for Payer: Global Benefits Group Commercial |
$19.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.95
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$20.72
|
| Rate for Payer: Prime Health Services Commercial |
$27.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
|
|
HC SOM CD4 T-CELL TOTAL CT
|
Facility
|
IP
|
$29.87
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914708
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.95
|
| Rate for Payer: EPIC Health Plan Senior |
$11.95
|
| Rate for Payer: Galaxy Health WC |
$25.39
|
| Rate for Payer: Global Benefits Group Commercial |
$17.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$23.90
|
| Rate for Payer: Networks By Design Commercial |
$19.42
|
| Rate for Payer: Prime Health Services Commercial |
$25.39
|
|
|
HC SOM CD4 T-CELL TOTAL CT
|
Facility
|
OP
|
$29.87
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914708
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$390.04 |
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$25.39
|
| Rate for Payer: Adventist Health Commercial |
$5.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.04
|
| Rate for Payer: Blue Shield of California Commercial |
$13.77
|
| Rate for Payer: Blue Shield of California Commercial |
$20.82
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cash Price |
$29.87
|
| Rate for Payer: Cigna of CA HMO |
$19.12
|
| Rate for Payer: Cigna of CA PPO |
$22.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: Global Benefits Group Commercial |
$17.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$23.90
|
| Rate for Payer: Networks By Design Commercial |
$19.42
|
| Rate for Payer: Prime Health Services Commercial |
$25.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM C DIFF PCR STOOL
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900914042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$444.31 |
| Rate for Payer: United Healthcare HMO Rider |
$30.19
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.31
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.50
|
| Rate for Payer: EPIC Health Plan Senior |
$41.00
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.94
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.19
|
| Rate for Payer: United Healthcare All Other HMO |
$30.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.00
|
| Rate for Payer: Vantage Medical Group Senior |
$37.27
|
|
|
HC SOM C DIFF PCR STOOL
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900914042
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC SOM CEA PANCREATIC CYST
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900912997
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.47
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.34
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.28
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.41
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.35
|
| Rate for Payer: United Healthcare All Other HMO |
$15.35
|
| Rate for Payer: United Healthcare HMO Rider |
$15.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC SOM CEA PANCREATIC CYST
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900912997
|
|
Hospital Revenue Code
|
301
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| 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 CEA PERITONEAL FLUID
|
Facility
|
IP
|
$60.12
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900914706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$51.10 |
| Rate for Payer: Adventist Health Commercial |
$12.02
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.05
|
| Rate for Payer: EPIC Health Plan Senior |
$24.05
|
| Rate for Payer: Galaxy Health WC |
$51.10
|
| Rate for Payer: Global Benefits Group Commercial |
$36.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.43
|
| Rate for Payer: Multiplan Commercial |
$48.10
|
| Rate for Payer: Networks By Design Commercial |
$39.08
|
| Rate for Payer: Prime Health Services Commercial |
$51.10
|
|
|
HC SOM CEA PERITONEAL FLUID
|
Facility
|
OP
|
$60.12
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
900914706
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: Adventist Health Commercial |
$12.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.47
|
| Rate for Payer: Blue Shield of California Commercial |
$27.72
|
| Rate for Payer: Blue Shield of California Commercial |
$41.90
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cash Price |
$60.12
|
| Rate for Payer: Cigna of CA HMO |
$38.48
|
| Rate for Payer: Cigna of CA PPO |
$44.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.28
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$51.10
|
| Rate for Payer: Global Benefits Group Commercial |
$36.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.41
|
| Rate for Payer: Multiplan Commercial |
$48.10
|
| Rate for Payer: Networks By Design Commercial |
$39.08
|
| Rate for Payer: Prime Health Services Commercial |
$51.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.35
|
| Rate for Payer: United Healthcare All Other HMO |
$15.35
|
| Rate for Payer: United Healthcare HMO Rider |
$15.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
