|
HC SOM GANGLIOSIDE AB IGM ASIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GANGLIOSIDE AB IGM DISIALO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM GANGLIOSIDE AB IGM DISIALO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GANGLIOSIDE AB IGM MONO
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM GANGLIOSIDE AB IGM MONO
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM GASTRIN
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM GASTRIN
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
900911200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$174.22 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.22
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.80
|
| Rate for Payer: EPIC Health Plan Senior |
$17.63
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.62
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.28
|
| Rate for Payer: United Healthcare All Other HMO |
$14.28
|
| Rate for Payer: United Healthcare HMO Rider |
$14.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: Vantage Medical Group Senior |
$17.63
|
|
|
HC SOM GHIVR 87901
|
Facility
|
IP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$313.42 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.49
|
| Rate for Payer: EPIC Health Plan Senior |
$147.49
|
| Rate for Payer: Galaxy Health WC |
$313.42
|
| Rate for Payer: Global Benefits Group Commercial |
$221.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$228.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Multiplan Commercial |
$294.98
|
| Rate for Payer: Networks By Design Commercial |
$239.67
|
| Rate for Payer: Prime Health Services Commercial |
$313.42
|
|
|
HC SOM GHIVR 87901
|
Facility
|
OP
|
$368.73
|
|
|
Service Code
|
CPT 87901
|
| Hospital Charge Code |
900914740
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$73.75 |
| Max. Negotiated Rate |
$2,541.18 |
| Rate for Payer: Adventist Health Commercial |
$73.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$241.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,541.18
|
| Rate for Payer: Blue Shield of California Commercial |
$246.68
|
| Rate for Payer: Blue Shield of California EPN |
$162.98
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Cash Price |
$368.73
|
| Rate for Payer: Cigna of CA HMO |
$235.99
|
| Rate for Payer: Cigna of CA PPO |
$272.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.56
|
| Rate for Payer: EPIC Health Plan Senior |
$257.45
|
| Rate for Payer: Galaxy Health WC |
$313.42
|
| Rate for Payer: Global Benefits Group Commercial |
$221.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$422.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$384.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$245.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$324.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.98
|
| Rate for Payer: Multiplan Commercial |
$294.98
|
| Rate for Payer: Networks By Design Commercial |
$239.67
|
| Rate for Payer: Prime Health Services Commercial |
$313.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$221.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$221.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.54
|
| Rate for Payer: United Healthcare All Other HMO |
$208.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$257.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$92.10 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.10
|
| Rate for Payer: Blue Shield of California Commercial |
$15.39
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM GIARDIA LAMBIA AG
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
900911396
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Adventist Health Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC SOM GLUCAGON
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC SOM GLUCAGON
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
900911016
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$119.83 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.83
|
| Rate for Payer: Blue Shield of California Commercial |
$25.42
|
| Rate for Payer: Blue Shield of California EPN |
$16.80
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.29
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.57
|
| Rate for Payer: United Healthcare All Other HMO |
$11.57
|
| Rate for Payer: United Healthcare HMO Rider |
$11.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.72
|
| Rate for Payer: Vantage Medical Group Senior |
$14.29
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
|
OP
|
$22.64
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.76
|
| Rate for Payer: Blue Shield of California Commercial |
$15.15
|
| Rate for Payer: Blue Shield of California EPN |
$10.01
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: Cigna of CA HMO |
$14.49
|
| Rate for Payer: Cigna of CA PPO |
$16.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.10
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
| Rate for Payer: Networks By Design Commercial |
$14.72
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.86
|
| Rate for Payer: United Healthcare All Other HMO |
$7.86
|
| Rate for Payer: United Healthcare HMO Rider |
$7.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.67
|
| Rate for Payer: Vantage Medical Group Senior |
$9.70
|
|
|
HC SOM GLUCOSE-6-PD SCR
|
Facility
|
IP
|
$22.64
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
900911305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$22.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.06
|
| Rate for Payer: EPIC Health Plan Senior |
$9.06
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
| Rate for Payer: Networks By Design Commercial |
$14.72
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$27.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$151.88 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.88
|
| Rate for Payer: Blue Shield of California Commercial |
$18.46
|
| Rate for Payer: Blue Shield of California EPN |
$12.20
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna of CA HMO |
$17.66
|
| Rate for Payer: Cigna of CA PPO |
$20.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$23.46
|
| Rate for Payer: Global Benefits Group Commercial |
$16.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$22.08
|
| Rate for Payer: Networks By Design Commercial |
$17.94
|
| Rate for Payer: Prime Health Services Commercial |
$23.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900911121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$23.46 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.04
|
| Rate for Payer: EPIC Health Plan Senior |
$11.04
|
| Rate for Payer: Galaxy Health WC |
$23.46
|
| Rate for Payer: Global Benefits Group Commercial |
$16.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.62
|
| Rate for Payer: Multiplan Commercial |
$22.08
|
| Rate for Payer: Networks By Design Commercial |
$17.94
|
| Rate for Payer: Prime Health Services Commercial |
$23.46
|
|
|
HC SOM GROWTH HORMONE
|
Facility
|
OP
|
$12.60
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$164.58 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.58
|
| Rate for Payer: Blue Shield of California Commercial |
$8.43
|
| Rate for Payer: Blue Shield of California EPN |
$5.57
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$8.06
|
| Rate for Payer: Cigna of CA PPO |
$9.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.50
|
| Rate for Payer: EPIC Health Plan Senior |
$16.67
|
| Rate for Payer: Galaxy Health WC |
$10.71
|
| Rate for Payer: Global Benefits Group Commercial |
$7.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.34
|
| Rate for Payer: Multiplan Commercial |
$10.08
|
| Rate for Payer: Networks By Design Commercial |
$8.19
|
| Rate for Payer: Prime Health Services Commercial |
$10.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.34
|
| Rate for Payer: Vantage Medical Group Senior |
$16.67
|
|
|
HC SOM GROWTH HORMONE
|
Facility
|
IP
|
$12.60
|
|
|
Service Code
|
CPT 83003
|
| Hospital Charge Code |
900911488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$10.71 |
| Rate for Payer: Adventist Health Commercial |
$2.52
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.04
|
| Rate for Payer: EPIC Health Plan Senior |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$10.71
|
| Rate for Payer: Global Benefits Group Commercial |
$7.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$10.08
|
| Rate for Payer: Networks By Design Commercial |
$8.19
|
| Rate for Payer: Prime Health Services Commercial |
$10.71
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM HALDOL(HALOPERIDOL) LEVEL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 80173
|
| Hospital Charge Code |
900911401
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.70
|
| Rate for Payer: Blue Shield of California Commercial |
$40.14
|
| Rate for Payer: Blue Shield of California EPN |
$26.52
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.15
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.78
|
| Rate for Payer: United Healthcare All Other HMO |
$12.78
|
| Rate for Payer: United Healthcare HMO Rider |
$12.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.36
|
| Rate for Payer: Vantage Medical Group Senior |
$15.78
|
|
|
HC SOM HANDLING FEE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| 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 HANDLING FEE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$96.89 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| 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 |
$96.89
|
| Rate for Payer: Blue Shield of California Commercial |
$23.41
|
| Rate for Payer: Blue Shield of California EPN |
$15.47
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| 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 |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| 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 HBEL ELECTROPHORESIS SUMMARY INTERP
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.99
|
| Rate for Payer: Blue Shield of California Commercial |
$113.07
|
| Rate for Payer: Blue Shield of California EPN |
$74.71
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: Cigna of CA HMO |
$108.17
|
| Rate for Payer: Cigna of CA PPO |
$125.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$143.67
|
| Rate for Payer: Global Benefits Group Commercial |
$101.41
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$135.22
|
| Rate for Payer: Networks By Design Commercial |
$109.86
|
| Rate for Payer: Prime Health Services Commercial |
$143.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM HBEL ELECTROPHORESIS SUMMARY INTERP
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915460
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$143.67 |
| Rate for Payer: Adventist Health Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$169.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.61
|
| Rate for Payer: EPIC Health Plan Senior |
$67.61
|
| Rate for Payer: Galaxy Health WC |
$143.67
|
| Rate for Payer: Global Benefits Group Commercial |
$101.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$135.22
|
| Rate for Payer: Networks By Design Commercial |
$109.86
|
| Rate for Payer: Prime Health Services Commercial |
$143.67
|
|
