|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
IP
|
$90.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$76.92 |
| Rate for Payer: Adventist Health Commercial |
$18.10
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36.20
|
| Rate for Payer: Galaxy Health WC |
$76.92
|
| Rate for Payer: Global Benefits Group Commercial |
$54.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.72
|
| Rate for Payer: Multiplan Commercial |
$72.40
|
| Rate for Payer: Networks By Design Commercial |
$58.83
|
| Rate for Payer: Prime Health Services Commercial |
$76.92
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Adventist Health Commercial |
$18.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$63.08
|
| Rate for Payer: Blue Shield of California Commercial |
$41.72
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna of CA HMO |
$57.92
|
| Rate for Payer: Cigna of CA PPO |
$66.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.20
|
| Rate for Payer: EPIC Health Plan Senior |
$36.20
|
| Rate for Payer: Galaxy Health WC |
$76.92
|
| Rate for Payer: Global Benefits Group Commercial |
$54.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.35
|
| Rate for Payer: Multiplan Commercial |
$72.40
|
| Rate for Payer: Networks By Design Commercial |
$58.83
|
| Rate for Payer: Prime Health Services Commercial |
$76.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.92
|
| Rate for Payer: Vantage Medical Group Senior |
$76.92
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
|
IP
|
$385.50
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$327.68 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.20
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.52
|
| Rate for Payer: Multiplan Commercial |
$308.40
|
| Rate for Payer: Networks By Design Commercial |
$250.57
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
|
OP
|
$385.50
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$1,233.08 |
| Rate for Payer: Adventist Health Commercial |
$77.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.08
|
| Rate for Payer: Blue Shield of California Commercial |
$177.72
|
| Rate for Payer: Blue Shield of California Commercial |
$268.69
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna of CA HMO |
$246.72
|
| Rate for Payer: Cigna of CA PPO |
$285.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$327.68
|
| Rate for Payer: Global Benefits Group Commercial |
$231.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$308.40
|
| Rate for Payer: Networks By Design Commercial |
$250.57
|
| Rate for Payer: Prime Health Services Commercial |
$327.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$111.52
|
| Rate for Payer: Blue Shield of California Commercial |
$73.76
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
IP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$147.08 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.22
|
| Rate for Payer: EPIC Health Plan Senior |
$69.22
|
| Rate for Payer: Galaxy Health WC |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$138.43
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
OP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$1,233.08 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,170.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,233.08
|
| Rate for Payer: Blue Shield of California Commercial |
$120.61
|
| Rate for Payer: Blue Shield of California Commercial |
$79.77
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cigna of CA HMO |
$110.75
|
| Rate for Payer: Cigna of CA PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$138.43
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB 1ST STAIN
|
Facility
|
OP
|
$61.76
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900915525
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$437.43 |
| Rate for Payer: Adventist Health Commercial |
$12.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.90
|
| Rate for Payer: Blue Shield of California Commercial |
$28.47
|
| Rate for Payer: Blue Shield of California Commercial |
$43.05
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Cigna of CA HMO |
$39.53
|
| Rate for Payer: Cigna of CA PPO |
$45.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$52.50
|
| Rate for Payer: Global Benefits Group Commercial |
$37.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$49.41
|
| Rate for Payer: Networks By Design Commercial |
$40.14
|
| Rate for Payer: Prime Health Services Commercial |
$52.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB 1ST STAIN
|
Facility
|
IP
|
$61.76
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900915525
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Adventist Health Commercial |
$12.35
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Senior |
$24.70
|
| Rate for Payer: Galaxy Health WC |
$52.50
|
| Rate for Payer: Global Benefits Group Commercial |
$37.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$49.41
|
| Rate for Payer: Networks By Design Commercial |
$40.14
|
| Rate for Payer: Prime Health Services Commercial |
$52.50
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
900915526
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$572.80 |
| Rate for Payer: Adventist Health Commercial |
$9.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.80
|
| Rate for Payer: Blue Shield of California Commercial |
$32.93
|
| Rate for Payer: Blue Shield of California Commercial |
$21.78
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cigna of CA HMO |
$30.23
|
| Rate for Payer: Cigna of CA PPO |
$34.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.90
|
| Rate for Payer: EPIC Health Plan Senior |
$18.90
|
| Rate for Payer: Galaxy Health WC |
$40.15
|
| Rate for Payer: Global Benefits Group Commercial |
$28.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$108.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.07
|
| Rate for Payer: Multiplan Commercial |
$37.79
|
| Rate for Payer: Networks By Design Commercial |
$30.71
|
| Rate for Payer: Prime Health Services Commercial |
$40.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.72
|
| Rate for Payer: United Healthcare All Other HMO |
$73.72
|
| Rate for Payer: United Healthcare HMO Rider |
$73.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.15
|
| Rate for Payer: Vantage Medical Group Senior |
$40.15
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
900915526
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Adventist Health Commercial |
$9.45
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.90
|
| Rate for Payer: EPIC Health Plan Senior |
$18.90
|
| Rate for Payer: Galaxy Health WC |
$40.15
|
| Rate for Payer: Global Benefits Group Commercial |
$28.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$37.79
|
| Rate for Payer: Networks By Design Commercial |
$30.71
|
| Rate for Payer: Prime Health Services Commercial |
$40.15
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$4,824.55 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,824.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$880.43
|
| Rate for Payer: Blue Shield of California Commercial |
$149.94
|
| Rate for Payer: Blue Shield of California Commercial |
$226.69
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.79
|
| Rate for Payer: EPIC Health Plan Senior |
$275.86
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$411.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.05
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.13
|
| Rate for Payer: United Healthcare All Other HMO |
$203.13
|
| Rate for Payer: United Healthcare HMO Rider |
$203.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$250.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Vantage Medical Group Senior |
$250.78
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$1,042.83 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,042.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.52
|
| Rate for Payer: Blue Shield of California Commercial |
$149.94
|
| Rate for Payer: Blue Shield of California Commercial |
$226.69
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.67
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.62
|
| Rate for Payer: United Healthcare All Other HMO |
$162.62
|
| Rate for Payer: United Healthcare HMO Rider |
$162.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$286.92 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.92
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.87
|
| Rate for Payer: EPIC Health Plan Senior |
$30.58
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.80
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
IP
|
$29.78
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$25.31 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.36
|
| Rate for Payer: Prime Health Services Commercial |
$25.31
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
OP
|
$29.78
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$13.73
|
| Rate for Payer: Blue Shield of California Commercial |
$20.76
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna of CA HMO |
$19.06
|
| Rate for Payer: Cigna of CA PPO |
$22.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$25.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$23.82
|
| Rate for Payer: Networks By Design Commercial |
$19.36
|
| Rate for Payer: Prime Health Services Commercial |
$25.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
OP
|
$27.01
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$149.12 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.45
|
| Rate for Payer: Blue Shield of California Commercial |
$18.83
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Cigna of CA HMO |
$17.29
|
| Rate for Payer: Cigna of CA PPO |
$19.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.25
|
| Rate for Payer: EPIC Health Plan Senior |
$22.16
|
| Rate for Payer: Galaxy Health WC |
$22.96
|
| Rate for Payer: Global Benefits Group Commercial |
$16.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$21.61
|
| Rate for Payer: Networks By Design Commercial |
$17.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.33
|
| Rate for Payer: United Healthcare All Other HMO |
$16.33
|
| Rate for Payer: United Healthcare HMO Rider |
$16.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
IP
|
$27.01
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.96
|
| Rate for Payer: Global Benefits Group Commercial |
$16.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$21.61
|
| Rate for Payer: Networks By Design Commercial |
$17.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.96
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| 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 |
$20.75
|
| Rate for Payer: Blue Shield of California Commercial |
$31.36
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| 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 |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| 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 |
$28.57
|
| 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 |
$10.80
|
| 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 |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| 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
|
|
|
HC SOM CMVQU 87497
|
Facility
|
OP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$153.93
|
| Rate for Payer: Blue Shield of California Commercial |
$232.73
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO |
$213.70
|
| Rate for Payer: Cigna of CA PPO |
$247.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$267.12
|
| Rate for Payer: Networks By Design Commercial |
$217.03
|
| Rate for Payer: Prime Health Services Commercial |
$283.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
