|
HC SOM FACTOR IX BETHESDA UNITS
|
Facility
|
OP
|
$130.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Adventist Health Commercial |
$26.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$60.13
|
| Rate for Payer: Blue Shield of California Commercial |
$90.92
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$96.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$110.87
|
| Rate for Payer: Global Benefits Group Commercial |
$78.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.31
|
| 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 |
$104.35
|
| Rate for Payer: Networks By Design Commercial |
$84.79
|
| Rate for Payer: Prime Health Services Commercial |
$110.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.26
|
| 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 FACTOR IX BETHESDA UNITS
|
Facility
|
IP
|
$130.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Adventist Health Commercial |
$26.09
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.18
|
| Rate for Payer: EPIC Health Plan Senior |
$52.18
|
| Rate for Payer: Galaxy Health WC |
$110.87
|
| Rate for Payer: Global Benefits Group Commercial |
$78.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.31
|
| Rate for Payer: Multiplan Commercial |
$104.35
|
| Rate for Payer: Networks By Design Commercial |
$84.79
|
| Rate for Payer: Prime Health Services Commercial |
$110.87
|
|
|
HC SOM FACTOR IX INHIB PROF INTERP
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.23
|
| 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 |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| 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 |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| 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 |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM FACTOR IX INHIB PROF INTERP
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915516
|
|
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 FACTOR IX INH. SCREEN
|
Facility
|
IP
|
$58.82
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Adventist Health Commercial |
$11.76
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.53
|
| Rate for Payer: EPIC Health Plan Senior |
$23.53
|
| Rate for Payer: Galaxy Health WC |
$50.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$47.06
|
| Rate for Payer: Networks By Design Commercial |
$38.23
|
| Rate for Payer: Prime Health Services Commercial |
$50.00
|
|
|
HC SOM FACTOR IX INH. SCREEN
|
Facility
|
OP
|
$58.82
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Adventist Health Commercial |
$11.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$27.12
|
| Rate for Payer: Blue Shield of California Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Cash Price |
$58.82
|
| Rate for Payer: Cigna of CA HMO |
$37.64
|
| Rate for Payer: Cigna of CA PPO |
$43.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$50.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.12
|
| 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 |
$47.06
|
| Rate for Payer: Networks By Design Commercial |
$38.23
|
| Rate for Payer: Prime Health Services Commercial |
$50.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.29
|
| 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 FACTOR VIII BETHESDA UNITS
|
Facility
|
IP
|
$130.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$110.87 |
| Rate for Payer: Galaxy Health WC |
$110.87
|
| Rate for Payer: EPIC Health Plan Senior |
$52.18
|
| Rate for Payer: Adventist Health Commercial |
$26.09
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.18
|
| Rate for Payer: Global Benefits Group Commercial |
$78.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.31
|
| Rate for Payer: Multiplan Commercial |
$104.35
|
| Rate for Payer: Networks By Design Commercial |
$84.79
|
| Rate for Payer: Prime Health Services Commercial |
$110.87
|
|
|
HC SOM FACTOR VIII BETHESDA UNITS
|
Facility
|
OP
|
$130.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Adventist Health Commercial |
$26.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$60.13
|
| Rate for Payer: Blue Shield of California Commercial |
$90.92
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$96.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$110.87
|
| Rate for Payer: Global Benefits Group Commercial |
$78.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.31
|
| 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 |
$104.35
|
| Rate for Payer: Networks By Design Commercial |
$84.79
|
| Rate for Payer: Prime Health Services Commercial |
$110.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.26
|
| 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 FACTOR VIII INHIB PROF INTERP
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.23
|
| 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 |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| 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 |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| 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 |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM FACTOR VIII INHIB PROF INTERP
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915510
|
|
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 FACTOR VIII INH. SCREEN
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900912803
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Shield of California Commercial |
$104.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.15
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| 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 |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| 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 FACTOR VIII INH. SCREEN
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900912803
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM FACTOR V LEIDEN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900915371
|
|
Hospital Revenue Code
|
310
|
| 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 FACTOR V LEIDEN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900915371
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$415.89 |
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.89
|
| 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: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.06
|
| Rate for Payer: EPIC Health Plan Senior |
$80.71
|
| 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 |
$120.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$73.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.32
|
| 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 |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$73.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC SOM FANBF 86038
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900914925
|
|
Hospital Revenue Code
|
301
|
| 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 FANBF 86038
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900914925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$124.73 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.73
|
| 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 |
$18.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.95
|
| Rate for Payer: EPIC Health Plan Senior |
$13.30
|
| 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 |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.20
|
| 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 |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC SOM FAP KNOWN MUT EXTRACT
|
Facility
|
IP
|
$318.21
|
|
|
Service Code
|
CPT 81202
|
| Hospital Charge Code |
900914620
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$270.48 |
| Rate for Payer: Adventist Health Commercial |
$63.64
|
| Rate for Payer: Cash Price |
$318.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.28
|
| Rate for Payer: EPIC Health Plan Senior |
$127.28
|
| Rate for Payer: Galaxy Health WC |
$270.48
|
| Rate for Payer: Global Benefits Group Commercial |
$190.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$187.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.37
|
| Rate for Payer: Multiplan Commercial |
$254.57
|
| Rate for Payer: Networks By Design Commercial |
$206.84
|
| Rate for Payer: Prime Health Services Commercial |
$270.48
|
|
|
HC SOM FAP KNOWN MUT EXTRACT
|
Facility
|
OP
|
$318.21
|
|
|
Service Code
|
CPT 81202
|
| Hospital Charge Code |
900914620
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Adventist Health Commercial |
$63.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$420.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$280.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.23
|
| Rate for Payer: Blue Shield of California Commercial |
$146.69
|
| Rate for Payer: Blue Shield of California Commercial |
$221.79
|
| Rate for Payer: Cash Price |
$318.21
|
| Rate for Payer: Cash Price |
$318.21
|
| Rate for Payer: Cigna of CA HMO |
$203.65
|
| Rate for Payer: Cigna of CA PPO |
$235.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$420.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$308.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$222.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$462.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$270.48
|
| Rate for Payer: Global Benefits Group Commercial |
$190.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$459.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$280.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$202.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$392.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$254.57
|
| Rate for Payer: Networks By Design Commercial |
$206.84
|
| Rate for Payer: Prime Health Services Commercial |
$270.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.80
|
| Rate for Payer: United Healthcare All Other HMO |
$226.80
|
| Rate for Payer: United Healthcare HMO Rider |
$226.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$280.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Vantage Medical Group Senior |
$280.00
|
|
|
HC SOM FASP 86606
|
Facility
|
OP
|
$77.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Adventist Health Commercial |
$15.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.21
|
| 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 |
$155.38
|
| Rate for Payer: Blue Shield of California Commercial |
$35.87
|
| Rate for Payer: Blue Shield of California Commercial |
$54.23
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Cigna of CA HMO |
$49.79
|
| Rate for Payer: Cigna of CA PPO |
$57.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$66.13
|
| Rate for Payer: Global Benefits Group Commercial |
$46.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.67
|
| 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 |
$62.24
|
| Rate for Payer: Networks By Design Commercial |
$50.57
|
| Rate for Payer: Prime Health Services Commercial |
$66.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.68
|
| 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 FASP 86606
|
Facility
|
IP
|
$77.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$66.13 |
| Rate for Payer: Galaxy Health WC |
$66.13
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Adventist Health Commercial |
$15.56
|
| Rate for Payer: Cash Price |
$77.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.12
|
| Rate for Payer: Global Benefits Group Commercial |
$46.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.67
|
| Rate for Payer: Multiplan Commercial |
$62.24
|
| Rate for Payer: Networks By Design Commercial |
$50.57
|
| Rate for Payer: Prime Health Services Commercial |
$66.13
|
|
|
HC SOM FAT FECAL QUANT
|
Facility
|
OP
|
$28.02
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
900911139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$173.44 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.44
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cigna of CA HMO |
$17.93
|
| Rate for Payer: Cigna of CA PPO |
$20.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.72
|
| Rate for Payer: EPIC Health Plan Senior |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$23.82
|
| Rate for Payer: Global Benefits Group Commercial |
$16.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Networks By Design Commercial |
$18.21
|
| Rate for Payer: Prime Health Services Commercial |
$23.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC SOM FAT FECAL QUANT
|
Facility
|
IP
|
$28.02
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
900911139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$23.82 |
| Rate for Payer: Adventist Health Commercial |
$5.60
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: EPIC Health Plan Senior |
$11.21
|
| Rate for Payer: Galaxy Health WC |
$23.82
|
| Rate for Payer: Global Benefits Group Commercial |
$16.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.42
|
| Rate for Payer: Networks By Design Commercial |
$18.21
|
| Rate for Payer: Prime Health Services Commercial |
$23.82
|
|
|
HC SOM FATTY ACIDS FREE
|
Facility
|
IP
|
$128.82
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900910286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$109.50 |
| Rate for Payer: Adventist Health Commercial |
$25.76
|
| Rate for Payer: Cash Price |
$128.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.53
|
| Rate for Payer: EPIC Health Plan Senior |
$51.53
|
| Rate for Payer: Galaxy Health WC |
$109.50
|
| Rate for Payer: Global Benefits Group Commercial |
$77.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.92
|
| Rate for Payer: Multiplan Commercial |
$103.06
|
| Rate for Payer: Networks By Design Commercial |
$83.73
|
| Rate for Payer: Prime Health Services Commercial |
$109.50
|
|
|
HC SOM FATTY ACIDS FREE
|
Facility
|
OP
|
$128.82
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900910286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$137.45 |
| Rate for Payer: Adventist Health Commercial |
$25.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.45
|
| Rate for Payer: Blue Shield of California Commercial |
$59.39
|
| Rate for Payer: Blue Shield of California Commercial |
$89.79
|
| Rate for Payer: Cash Price |
$128.82
|
| Rate for Payer: Cash Price |
$128.82
|
| Rate for Payer: Cigna of CA HMO |
$82.44
|
| Rate for Payer: Cigna of CA PPO |
$95.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Senior |
$20.65
|
| Rate for Payer: Galaxy Health WC |
$109.50
|
| Rate for Payer: Global Benefits Group Commercial |
$77.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$103.06
|
| Rate for Payer: Networks By Design Commercial |
$83.73
|
| Rate for Payer: Prime Health Services Commercial |
$109.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.20
|
| Rate for Payer: United Healthcare All Other HMO |
$15.20
|
| Rate for Payer: United Healthcare HMO Rider |
$15.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.77
|
|
|
HC SOM FATTY ACIDS PEROXISOMAL
|
Facility
|
OP
|
$94.37
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
900911471
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$18.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$43.50
|
| Rate for Payer: Blue Shield of California Commercial |
$65.78
|
| Rate for Payer: Cash Price |
$94.37
|
| Rate for Payer: Cash Price |
$94.37
|
| Rate for Payer: Cigna of CA HMO |
$60.40
|
| Rate for Payer: Cigna of CA PPO |
$69.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$66.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.59
|
| Rate for Payer: EPIC Health Plan Senior |
$21.73
|
| Rate for Payer: Galaxy Health WC |
$80.21
|
| Rate for Payer: Global Benefits Group Commercial |
$56.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.46
|
| Rate for Payer: Multiplan Commercial |
$75.50
|
| Rate for Payer: Networks By Design Commercial |
$61.34
|
| Rate for Payer: Prime Health Services Commercial |
$80.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.73
|
| Rate for Payer: Vantage Medical Group Senior |
$19.75
|
|
