|
HC SOM DIHYDROTESTERONE
|
Facility
|
OP
|
$43.87
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$208.74 |
| Rate for Payer: Adventist Health Commercial |
$8.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$192.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.74
|
| Rate for Payer: Blue Shield of California Commercial |
$20.22
|
| Rate for Payer: Blue Shield of California Commercial |
$30.58
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Cigna of CA HMO |
$28.08
|
| Rate for Payer: Cigna of CA PPO |
$32.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.21
|
| Rate for Payer: Galaxy Health WC |
$37.29
|
| Rate for Payer: Global Benefits Group Commercial |
$26.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$28.52
|
| Rate for Payer: Prime Health Services Commercial |
$37.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.71
|
| Rate for Payer: United Healthcare All Other HMO |
$23.71
|
| Rate for Payer: United Healthcare HMO Rider |
$23.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
IP
|
$43.87
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$37.29 |
| Rate for Payer: Adventist Health Commercial |
$8.77
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Senior |
$17.55
|
| Rate for Payer: Galaxy Health WC |
$37.29
|
| Rate for Payer: Global Benefits Group Commercial |
$26.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.53
|
| Rate for Payer: Multiplan Commercial |
$35.10
|
| Rate for Payer: Networks By Design Commercial |
$28.52
|
| Rate for Payer: Prime Health Services Commercial |
$37.29
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
OP
|
$14.36
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$144.68 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.68
|
| Rate for Payer: Blue Shield of California Commercial |
$10.01
|
| Rate for Payer: Blue Shield of California Commercial |
$6.62
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cigna of CA HMO |
$9.19
|
| Rate for Payer: Cigna of CA PPO |
$10.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Senior |
$15.14
|
| Rate for Payer: Galaxy Health WC |
$12.21
|
| Rate for Payer: Global Benefits Group Commercial |
$8.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.44
|
| Rate for Payer: Multiplan Commercial |
$11.49
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: Prime Health Services Commercial |
$12.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$13.76
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
IP
|
$14.36
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.74
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$12.21
|
| Rate for Payer: Global Benefits Group Commercial |
$8.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Multiplan Commercial |
$11.49
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: Prime Health Services Commercial |
$12.21
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.53
|
| Rate for Payer: EPIC Health Plan Senior |
$5.53
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$136.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.26
|
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.82
|
| Rate for Payer: Blue Shield of California Commercial |
$6.38
|
| Rate for Payer: Blue Shield of California Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cigna of CA HMO |
$8.85
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.57
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
OP
|
$34.72
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Adventist Health Commercial |
$6.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Blue Shield of California Commercial |
$16.01
|
| Rate for Payer: Blue Shield of California Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Cigna of CA HMO |
$22.22
|
| Rate for Payer: Cigna of CA PPO |
$25.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$29.51
|
| Rate for Payer: Global Benefits Group Commercial |
$20.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$27.78
|
| Rate for Payer: Networks By Design Commercial |
$22.57
|
| Rate for Payer: Prime Health Services Commercial |
$29.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
IP
|
$34.72
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$29.51 |
| Rate for Payer: Adventist Health Commercial |
$6.94
|
| Rate for Payer: Cash Price |
$34.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.89
|
| Rate for Payer: Galaxy Health WC |
$29.51
|
| Rate for Payer: Global Benefits Group Commercial |
$20.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.33
|
| Rate for Payer: Multiplan Commercial |
$27.78
|
| Rate for Payer: Networks By Design Commercial |
$22.57
|
| Rate for Payer: Prime Health Services Commercial |
$29.51
|
|
|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.60
|
| Rate for Payer: Blue Shield of California Commercial |
$34.58
|
| Rate for Payer: Blue Shield of California Commercial |
$52.27
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.05
|
| Rate for Payer: EPIC Health Plan Senior |
$150.70
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM DNA EXTRACTION
|
Facility
|
IP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$173.07 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.44
|
| Rate for Payer: EPIC Health Plan Senior |
$81.44
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.87
|
| Rate for Payer: Multiplan Commercial |
$162.89
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
|
|
HC SOM DNA EXTRACTION
|
Facility
|
OP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$271.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.60
|
| Rate for Payer: Blue Shield of California Commercial |
$141.92
|
| Rate for Payer: Blue Shield of California Commercial |
$93.86
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cigna of CA HMO |
$130.31
|
| Rate for Payer: Cigna of CA PPO |
$150.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.05
|
| Rate for Payer: EPIC Health Plan Senior |
$150.70
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$162.89
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
OP
|
$63.30
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$636.03 |
| Rate for Payer: Cigna of CA PPO |
$46.84
|
| Rate for Payer: Adventist Health Commercial |
$12.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$29.18
|
| Rate for Payer: Blue Shield of California Commercial |
$44.12
|
| Rate for Payer: Cash Price |
$63.30
|
| Rate for Payer: Cash Price |
$63.30
|
| Rate for Payer: Cigna of CA HMO |
$40.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$53.80
|
| Rate for Payer: Global Benefits Group Commercial |
$37.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$50.64
|
| Rate for Payer: Networks By Design Commercial |
$41.15
|
| Rate for Payer: Prime Health Services Commercial |
$53.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
IP
|
$63.30
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$53.80 |
| Rate for Payer: Adventist Health Commercial |
$12.66
|
| Rate for Payer: Cash Price |
$63.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.32
|
| Rate for Payer: EPIC Health Plan Senior |
$25.32
|
| Rate for Payer: Galaxy Health WC |
$53.80
|
| Rate for Payer: Global Benefits Group Commercial |
$37.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.19
|
| Rate for Payer: Multiplan Commercial |
$50.64
|
| Rate for Payer: Networks By Design Commercial |
$41.15
|
| Rate for Payer: Prime Health Services Commercial |
$53.80
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$636.03 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DULOX 80299
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$38.79 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$18.25
|
| Rate for Payer: Galaxy Health WC |
$38.79
|
| Rate for Payer: Global Benefits Group Commercial |
$27.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$36.50
|
| Rate for Payer: Networks By Design Commercial |
$29.66
|
| Rate for Payer: Prime Health Services Commercial |
$38.79
|
|
|
HC SOM DULOX 80299
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.04
|
| Rate for Payer: Blue Shield of California Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cigna of CA HMO |
$29.20
|
| Rate for Payer: Cigna of CA PPO |
$33.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$38.79
|
| Rate for Payer: Global Benefits Group Commercial |
$27.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$36.50
|
| Rate for Payer: Networks By Design Commercial |
$29.66
|
| Rate for Payer: Prime Health Services Commercial |
$38.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM EBV PCR QUANT
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM EBV PCR QUANT
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$23.17
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ECHINOCOCCUS AB
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.50
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.47
|
| Rate for Payer: EPIC Health Plan Senior |
$14.31
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM ECHINOCOCCUS AB
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM EHRLICHOSIS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$104.93 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.93
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC SOM EHRLICHOSIS
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
900911388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC SOM ELECTROPHORES,PROTEN,RANDM
|
Facility
|
IP
|
$20.05
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912891
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Adventist Health Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.02
|
| Rate for Payer: EPIC Health Plan Senior |
$8.02
|
| Rate for Payer: Galaxy Health WC |
$17.04
|
| Rate for Payer: Global Benefits Group Commercial |
$12.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$16.04
|
| Rate for Payer: Networks By Design Commercial |
$13.03
|
| Rate for Payer: Prime Health Services Commercial |
$17.04
|
|
