|
HC SOM CMVQU 87497
|
Facility
|
IP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$283.81 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.56
|
| Rate for Payer: EPIC Health Plan Senior |
$133.56
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.14
|
| 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
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$129.08
|
| Rate for Payer: Blue Shield of California Commercial |
$195.16
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.02
|
| Rate for Payer: Blue Shield of California Commercial |
$129.08
|
| Rate for Payer: Blue Shield of California Commercial |
$195.16
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
OP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$184.84 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.84
|
| Rate for Payer: Blue Shield of California Commercial |
$34.72
|
| Rate for Payer: Blue Shield of California Commercial |
$52.50
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cigna of CA HMO |
$48.20
|
| Rate for Payer: Cigna of CA PPO |
$55.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.54
|
| Rate for Payer: EPIC Health Plan Senior |
$19.69
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$60.26
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
IP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.13
|
| Rate for Payer: EPIC Health Plan Senior |
$30.13
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.08
|
| Rate for Payer: Multiplan Commercial |
$60.26
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
|
|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
IP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$189.08 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.98
|
| Rate for Payer: EPIC Health Plan Senior |
$88.98
|
| Rate for Payer: Galaxy Health WC |
$189.08
|
| Rate for Payer: Global Benefits Group Commercial |
$133.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$131.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.39
|
| Rate for Payer: Multiplan Commercial |
$177.96
|
| Rate for Payer: Networks By Design Commercial |
$144.59
|
| Rate for Payer: Prime Health Services Commercial |
$189.08
|
|
|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
OP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$189.08 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| 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 |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$102.55
|
| Rate for Payer: Blue Shield of California Commercial |
$155.05
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Cigna of CA HMO |
$142.37
|
| Rate for Payer: Cigna of CA PPO |
$164.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$189.08
|
| Rate for Payer: Global Benefits Group Commercial |
$133.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.39
|
| 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 |
$177.96
|
| Rate for Payer: Networks By Design Commercial |
$144.59
|
| Rate for Payer: Prime Health Services Commercial |
$189.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.47
|
| 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 COCCI AB IGG CSF BY CF
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna of CA HMO |
$11.36
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGG CSF BY CF
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.10
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.26
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
|
|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.10
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.26
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
|
|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna of CA HMO |
$11.36
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
IP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.10
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.26
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$3.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna of CA HMO |
$11.36
|
| Rate for Payer: Cigna of CA PPO |
$13.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$15.09
|
| Rate for Payer: Global Benefits Group Commercial |
$10.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$15.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$120.08 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.08
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.93
|
| Rate for Payer: EPIC Health Plan Senior |
$12.62
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$1,716.59 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,383.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,716.59
|
| Rate for Payer: Blue Shield of California Commercial |
$43.22
|
| Rate for Payer: Blue Shield of California Commercial |
$65.34
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cigna of CA HMO |
$60.00
|
| Rate for Payer: Cigna of CA PPO |
$69.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.54
|
| Rate for Payer: EPIC Health Plan Senior |
$191.03
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$284.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$280.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.66
|
| Rate for Payer: United Healthcare All Other HMO |
$140.66
|
| Rate for Payer: United Healthcare HMO Rider |
$140.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$79.69 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.50
|
| Rate for Payer: EPIC Health Plan Senior |
$37.50
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$123.90 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.90
|
| Rate for Payer: Blue Shield of California Commercial |
$14.75
|
| Rate for Payer: Blue Shield of California Commercial |
$22.30
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
