|
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 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 HANDLING FEE
|
Facility
|
OP
|
$39.00
|
|
|
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 |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.89
|
| Rate for Payer: Blue Shield of California Commercial |
$26.09
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| 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 |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
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 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
|
|
|
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 VARIANT, A2 AND F QUANTITATION,B
|
Facility
|
OP
|
$12.82
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$107.99 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.41
|
| 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 |
$8.58
|
| Rate for Payer: Blue Shield of California EPN |
$5.67
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cigna of CA HMO |
$8.20
|
| Rate for Payer: Cigna of CA PPO |
$9.49
|
| 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 |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| 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 |
$8.55
|
| 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 |
$3.08
|
| 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 |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.69
|
| 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 VARIANT, A2 AND F QUANTITATION,B
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900915458
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.13
|
| Rate for Payer: EPIC Health Plan Senior |
$5.13
|
| Rate for Payer: Galaxy Health WC |
$10.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.08
|
| Rate for Payer: Multiplan Commercial |
$10.26
|
| Rate for Payer: Networks By Design Commercial |
$8.33
|
| Rate for Payer: Prime Health Services Commercial |
$10.90
|
|
|
HC SOM HBEL VARIANT B
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
900915459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.96
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.38
|
| Rate for Payer: EPIC Health Plan Senior |
$18.06
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM HBEL VARIANT B
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
900915459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC SOM HCG HIGH SENSITIVITY
|
Facility
|
OP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$142.30 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.22
|
| Rate for Payer: Blue Shield of California EPN |
$7.41
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cigna of CA HMO |
$10.73
|
| Rate for Payer: Cigna of CA PPO |
$12.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$14.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$10.90
|
| Rate for Payer: Prime Health Services Commercial |
$14.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM HCG HIGH SENSITIVITY
|
Facility
|
IP
|
$16.77
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
900914546
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.71
|
| Rate for Payer: EPIC Health Plan Senior |
$6.71
|
| Rate for Payer: Galaxy Health WC |
$14.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$10.90
|
| Rate for Payer: Prime Health Services Commercial |
$14.25
|
|
|
HC SOM HCV GENOTYPING
|
Facility
|
IP
|
$125.55
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Senior |
$50.22
|
| Rate for Payer: Galaxy Health WC |
$106.72
|
| Rate for Payer: Global Benefits Group Commercial |
$75.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.13
|
| Rate for Payer: Multiplan Commercial |
$100.44
|
| Rate for Payer: Networks By Design Commercial |
$81.61
|
| Rate for Payer: Prime Health Services Commercial |
$106.72
|
|
|
HC SOM HCV GENOTYPING
|
Facility
|
OP
|
$125.55
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
900911374
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.11 |
| Max. Negotiated Rate |
$2,541.18 |
| Rate for Payer: Adventist Health Commercial |
$25.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.35
|
| 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 |
$83.99
|
| Rate for Payer: Blue Shield of California EPN |
$55.49
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Cash Price |
$125.55
|
| Rate for Payer: Cigna of CA HMO |
$80.35
|
| Rate for Payer: Cigna of CA PPO |
$92.91
|
| 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 |
$106.72
|
| Rate for Payer: Global Benefits Group Commercial |
$75.33
|
| 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 |
$83.74
|
| 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 |
$30.13
|
| 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 |
$100.44
|
| Rate for Payer: Networks By Design Commercial |
$81.61
|
| Rate for Payer: Prime Health Services Commercial |
$106.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.33
|
| 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 HEMO A INV INTERP
|
Facility
|
IP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$470.09 |
| Rate for Payer: Adventist Health Commercial |
$110.61
|
| Rate for Payer: Cash Price |
$553.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.22
|
| Rate for Payer: EPIC Health Plan Senior |
$221.22
|
| Rate for Payer: Galaxy Health WC |
$470.09
|
| Rate for Payer: Global Benefits Group Commercial |
$331.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.73
|
| Rate for Payer: Multiplan Commercial |
$442.44
|
| Rate for Payer: Networks By Design Commercial |
$359.48
|
| Rate for Payer: Prime Health Services Commercial |
$470.09
|
|
|
HC SOM HEMO A INV INTERP
|
Facility
|
OP
|
$553.05
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914242
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$1,478.16 |
| Rate for Payer: Adventist Health Commercial |
$110.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,478.16
|
| Rate for Payer: Blue Shield of California Commercial |
$369.99
|
| Rate for Payer: Blue Shield of California EPN |
$244.45
|
| Rate for Payer: Cash Price |
$553.05
|
| Rate for Payer: Cash Price |
$553.05
|
| Rate for Payer: Cigna of CA HMO |
$353.95
|
| Rate for Payer: Cigna of CA PPO |
$409.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$470.09
|
| Rate for Payer: Global Benefits Group Commercial |
$331.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$442.44
|
| Rate for Payer: Networks By Design Commercial |
$359.48
|
| Rate for Payer: Prime Health Services Commercial |
$470.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$331.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
|
IP
|
$95.84
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Adventist Health Commercial |
$19.17
|
| Rate for Payer: Cash Price |
$95.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.34
|
| Rate for Payer: EPIC Health Plan Senior |
$38.34
|
| Rate for Payer: Galaxy Health WC |
$81.46
|
| Rate for Payer: Global Benefits Group Commercial |
$57.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$76.67
|
| Rate for Payer: Networks By Design Commercial |
$62.30
|
| Rate for Payer: Prime Health Services Commercial |
$81.46
|
|
|
HC SOM HEMOCHROMATOSIS GENE PCR
|
Facility
|
OP
|
$95.84
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
900910606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Adventist Health Commercial |
$19.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.98
|
| Rate for Payer: Blue Shield of California Commercial |
$64.12
|
| Rate for Payer: Blue Shield of California EPN |
$42.36
|
| Rate for Payer: Cash Price |
$95.84
|
| Rate for Payer: Cash Price |
$95.84
|
| Rate for Payer: Cigna of CA HMO |
$61.34
|
| Rate for Payer: Cigna of CA PPO |
$70.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.24
|
| Rate for Payer: EPIC Health Plan Senior |
$65.36
|
| Rate for Payer: Galaxy Health WC |
$81.46
|
| Rate for Payer: Global Benefits Group Commercial |
$57.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$107.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$65.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.58
|
| Rate for Payer: Multiplan Commercial |
$76.67
|
| Rate for Payer: Networks By Design Commercial |
$62.30
|
| Rate for Payer: Prime Health Services Commercial |
$81.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.94
|
| Rate for Payer: United Healthcare All Other HMO |
$52.94
|
| Rate for Payer: United Healthcare HMO Rider |
$52.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$65.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.90
|
| Rate for Payer: Vantage Medical Group Senior |
$65.36
|
|
|
HC SOM HEMOSIDERIN, URINE
|
Facility
|
OP
|
$125.67
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$106.82 |
| Rate for Payer: Adventist Health Commercial |
$25.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.88
|
| Rate for Payer: Blue Shield of California Commercial |
$84.07
|
| Rate for Payer: Blue Shield of California EPN |
$55.55
|
| Rate for Payer: Cash Price |
$125.67
|
| Rate for Payer: Cash Price |
$125.67
|
| Rate for Payer: Cigna of CA HMO |
$80.43
|
| Rate for Payer: Cigna of CA PPO |
$93.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$106.82
|
| Rate for Payer: Global Benefits Group Commercial |
$75.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$100.54
|
| Rate for Payer: Networks By Design Commercial |
$81.69
|
| Rate for Payer: Prime Health Services Commercial |
$106.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM HEMOSIDERIN, URINE
|
Facility
|
IP
|
$125.67
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
900910748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$106.82 |
| Rate for Payer: Adventist Health Commercial |
$25.13
|
| Rate for Payer: Cash Price |
$125.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.27
|
| Rate for Payer: EPIC Health Plan Senior |
$50.27
|
| Rate for Payer: Galaxy Health WC |
$106.82
|
| Rate for Payer: Global Benefits Group Commercial |
$75.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.16
|
| Rate for Payer: Multiplan Commercial |
$100.54
|
| Rate for Payer: Networks By Design Commercial |
$81.69
|
| Rate for Payer: Prime Health Services Commercial |
$106.82
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM HEPARIN-PF4 AB
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900912527
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$153.94 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.94
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
|
IP
|
$79.33
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$67.43 |
| Rate for Payer: Adventist Health Commercial |
$15.87
|
| Rate for Payer: Cash Price |
$79.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.73
|
| Rate for Payer: EPIC Health Plan Senior |
$31.73
|
| Rate for Payer: Galaxy Health WC |
$67.43
|
| Rate for Payer: Global Benefits Group Commercial |
$47.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.04
|
| Rate for Payer: Multiplan Commercial |
$63.46
|
| Rate for Payer: Networks By Design Commercial |
$51.56
|
| Rate for Payer: Prime Health Services Commercial |
$67.43
|
|
|
HC SOM HEPATITIS B DNA (QUANT)
|
Facility
|
OP
|
$79.33
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
900911402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Adventist Health Commercial |
$15.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$53.07
|
| Rate for Payer: Blue Shield of California EPN |
$35.06
|
| Rate for Payer: Cash Price |
$79.33
|
| Rate for Payer: Cash Price |
$79.33
|
| Rate for Payer: Cigna of CA HMO |
$50.77
|
| Rate for Payer: Cigna of CA PPO |
$58.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$67.43
|
| Rate for Payer: Global Benefits Group Commercial |
$47.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$63.46
|
| Rate for Payer: Networks By Design Commercial |
$51.56
|
| Rate for Payer: Prime Health Services Commercial |
$67.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM HEPATITIS BE AB
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
900911195
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| 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
|
|
