|
HC SOM FISH B ALL
|
Facility
|
IP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: EPIC Health Plan Senior |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.75
|
| Rate for Payer: Global Benefits Group Commercial |
$102.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.87
|
| Rate for Payer: Multiplan Commercial |
$136.24
|
| Rate for Payer: Networks By Design Commercial |
$110.69
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
IP
|
$203.22
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$172.74 |
| Rate for Payer: Adventist Health Commercial |
$40.64
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.29
|
| Rate for Payer: EPIC Health Plan Senior |
$81.29
|
| Rate for Payer: Galaxy Health WC |
$172.74
|
| Rate for Payer: Global Benefits Group Commercial |
$121.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.77
|
| Rate for Payer: Multiplan Commercial |
$162.58
|
| Rate for Payer: Networks By Design Commercial |
$132.09
|
| Rate for Payer: Prime Health Services Commercial |
$172.74
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
OP
|
$203.22
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Adventist Health Commercial |
$40.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$93.68
|
| Rate for Payer: Blue Shield of California Commercial |
$141.64
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Cigna of CA HMO |
$130.06
|
| Rate for Payer: Cigna of CA PPO |
$150.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.29
|
| Rate for Payer: EPIC Health Plan Senior |
$81.29
|
| Rate for Payer: Galaxy Health WC |
$172.74
|
| Rate for Payer: Global Benefits Group Commercial |
$121.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.25
|
| Rate for Payer: Multiplan Commercial |
$162.58
|
| Rate for Payer: Networks By Design Commercial |
$132.09
|
| Rate for Payer: Prime Health Services Commercial |
$172.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$172.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.74
|
| Rate for Payer: Vantage Medical Group Senior |
$172.74
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$243.95
|
| Rate for Payer: Blue Shield of California Commercial |
$161.35
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| 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 FISH MDS LOCUS ANOMALIES
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$69.15
|
| Rate for Payer: Blue Shield of California Commercial |
$104.55
|
| 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 |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| 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 |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
OP
|
$204.69
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Adventist Health Commercial |
$40.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$153.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$94.36
|
| Rate for Payer: Blue Shield of California Commercial |
$142.67
|
| Rate for Payer: Cash Price |
$204.69
|
| Rate for Payer: Cash Price |
$204.69
|
| Rate for Payer: Cigna of CA HMO |
$131.00
|
| Rate for Payer: Cigna of CA PPO |
$151.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.88
|
| Rate for Payer: EPIC Health Plan Senior |
$81.88
|
| Rate for Payer: Galaxy Health WC |
$173.99
|
| Rate for Payer: Global Benefits Group Commercial |
$122.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.28
|
| Rate for Payer: Multiplan Commercial |
$163.75
|
| Rate for Payer: Networks By Design Commercial |
$133.05
|
| Rate for Payer: Prime Health Services Commercial |
$173.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.99
|
| Rate for Payer: Vantage Medical Group Senior |
$173.99
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
IP
|
$204.69
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.94 |
| Max. Negotiated Rate |
$173.99 |
| Rate for Payer: Adventist Health Commercial |
$40.94
|
| Rate for Payer: Cash Price |
$204.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.88
|
| Rate for Payer: EPIC Health Plan Senior |
$81.88
|
| Rate for Payer: Galaxy Health WC |
$173.99
|
| Rate for Payer: Global Benefits Group Commercial |
$122.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.13
|
| Rate for Payer: Multiplan Commercial |
$163.75
|
| Rate for Payer: Networks By Design Commercial |
$133.05
|
| Rate for Payer: Prime Health Services Commercial |
$173.99
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
|
IP
|
$217.35
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$184.75 |
| Rate for Payer: Adventist Health Commercial |
$43.47
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.94
|
| Rate for Payer: EPIC Health Plan Senior |
$86.94
|
| Rate for Payer: Galaxy Health WC |
$184.75
|
| Rate for Payer: Global Benefits Group Commercial |
$130.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.16
|
| Rate for Payer: Multiplan Commercial |
$173.88
|
| Rate for Payer: Networks By Design Commercial |
$141.28
|
| Rate for Payer: Prime Health Services Commercial |
$184.75
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
|
OP
|
$217.35
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Adventist Health Commercial |
$43.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$151.49
|
| Rate for Payer: Blue Shield of California Commercial |
$100.20
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cigna of CA HMO |
$139.10
|
| Rate for Payer: Cigna of CA PPO |
$160.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$184.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.94
|
| Rate for Payer: EPIC Health Plan Senior |
$86.94
|
| Rate for Payer: Galaxy Health WC |
$184.75
|
| Rate for Payer: Global Benefits Group Commercial |
$130.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.15
|
| Rate for Payer: Multiplan Commercial |
$173.88
|
| Rate for Payer: Networks By Design Commercial |
$141.28
|
| Rate for Payer: Prime Health Services Commercial |
$184.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.75
|
| Rate for Payer: Vantage Medical Group Senior |
$184.75
|
|
|
HC SOM FISH UROTHELIAL CANCER
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$2,992.06 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,909.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,992.06
|
| Rate for Payer: Blue Shield of California Commercial |
$202.84
|
| Rate for Payer: Blue Shield of California Commercial |
$306.68
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$281.60
|
| Rate for Payer: Cigna of CA PPO |
$325.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$610.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$690.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOM FISH UROTHELIAL CANCER
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$176.00
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$279.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$259.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
|
|
HC SOM FLECAINIDE ACETATE
|
Facility
|
IP
|
$44.23
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: Adventist Health Commercial |
$8.85
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.69
|
| Rate for Payer: EPIC Health Plan Senior |
$17.69
|
| Rate for Payer: Galaxy Health WC |
$37.60
|
| Rate for Payer: Global Benefits Group Commercial |
$26.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$35.38
|
| Rate for Payer: Networks By Design Commercial |
$28.75
|
| Rate for Payer: Prime Health Services Commercial |
$37.60
|
|
|
HC SOM FLECAINIDE ACETATE
|
Facility
|
OP
|
$44.23
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$110.12 |
| Rate for Payer: Adventist Health Commercial |
$8.85
|
| 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 |
$68.10
|
| Rate for Payer: Blue Shield of California Commercial |
$20.39
|
| Rate for Payer: Blue Shield of California Commercial |
$30.83
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Cash Price |
$44.23
|
| Rate for Payer: Cigna of CA HMO |
$28.31
|
| Rate for Payer: Cigna of CA PPO |
$32.73
|
| 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 |
$30.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$37.60
|
| Rate for Payer: Global Benefits Group Commercial |
$26.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.62
|
| 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 |
$35.38
|
| Rate for Payer: Networks By Design Commercial |
$28.75
|
| Rate for Payer: Prime Health Services Commercial |
$37.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.54
|
| 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 FLEXERIL
|
Facility
|
IP
|
$69.57
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$59.13 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.83
|
| Rate for Payer: EPIC Health Plan Senior |
$27.83
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$55.66
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
|
|
HC SOM FLEXERIL
|
Facility
|
OP
|
$69.57
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$174.49 |
| Rate for Payer: Vantage Medical Group Senior |
$59.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.13
|
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.49
|
| Rate for Payer: Blue Shield of California Commercial |
$32.07
|
| Rate for Payer: Blue Shield of California Commercial |
$48.49
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cigna of CA HMO |
$44.52
|
| Rate for Payer: Cigna of CA PPO |
$51.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.83
|
| Rate for Payer: EPIC Health Plan Senior |
$27.83
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.70
|
| Rate for Payer: Multiplan Commercial |
$55.66
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.78
|
| Rate for Payer: United Healthcare All Other HMO |
$34.78
|
| Rate for Payer: United Healthcare HMO Rider |
$34.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.13
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$138.12 |
| Rate for Payer: Adventist Health Commercial |
$32.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Senior |
$65.00
|
| Rate for Payer: Galaxy Health WC |
$138.12
|
| Rate for Payer: Global Benefits Group Commercial |
$97.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$130.00
|
| Rate for Payer: Networks By Design Commercial |
$105.62
|
| Rate for Payer: Prime Health Services Commercial |
$138.12
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$32.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.32
|
| Rate for Payer: Blue Shield of California Commercial |
$113.26
|
| Rate for Payer: Blue Shield of California Commercial |
$74.91
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna of CA HMO |
$104.00
|
| Rate for Payer: Cigna of CA PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$138.12
|
| Rate for Payer: Global Benefits Group Commercial |
$97.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$130.00
|
| Rate for Payer: Networks By Design Commercial |
$105.62
|
| Rate for Payer: Prime Health Services Commercial |
$138.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$646.73 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.73
|
| Rate for Payer: Blue Shield of California Commercial |
$115.00
|
| Rate for Payer: Blue Shield of California Commercial |
$76.06
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.09
|
| Rate for Payer: EPIC Health Plan Senior |
$182.06
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.78
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.06
|
| Rate for Payer: United Healthcare All Other HMO |
$134.06
|
| Rate for Payer: United Healthcare HMO Rider |
$134.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: Vantage Medical Group Senior |
$165.51
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
|
OP
|
$120.20
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$191.37 |
| Rate for Payer: Adventist Health Commercial |
$24.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.37
|
| Rate for Payer: Blue Shield of California Commercial |
$55.41
|
| Rate for Payer: Blue Shield of California Commercial |
$83.78
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: Cigna of CA HMO |
$76.93
|
| Rate for Payer: Cigna of CA PPO |
$88.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.59
|
| Rate for Payer: EPIC Health Plan Senior |
$20.39
|
| Rate for Payer: Galaxy Health WC |
$102.17
|
| Rate for Payer: Global Benefits Group Commercial |
$72.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: Networks By Design Commercial |
$78.13
|
| Rate for Payer: Prime Health Services Commercial |
$102.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.02
|
| Rate for Payer: United Healthcare All Other HMO |
$15.02
|
| Rate for Payer: United Healthcare HMO Rider |
$15.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
|
IP
|
$120.20
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$102.17 |
| Rate for Payer: Adventist Health Commercial |
$24.04
|
| Rate for Payer: Cash Price |
$120.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.08
|
| Rate for Payer: EPIC Health Plan Senior |
$48.08
|
| Rate for Payer: Galaxy Health WC |
$102.17
|
| Rate for Payer: Global Benefits Group Commercial |
$72.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.85
|
| Rate for Payer: Multiplan Commercial |
$96.16
|
| Rate for Payer: Networks By Design Commercial |
$78.13
|
| Rate for Payer: Prime Health Services Commercial |
$102.17
|
|
|
HC SOM FLUOXETINE
|
Facility
|
IP
|
$54.29
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| Rate for Payer: Cash Price |
$54.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.72
|
| Rate for Payer: EPIC Health Plan Senior |
$21.72
|
| Rate for Payer: Galaxy Health WC |
$46.15
|
| Rate for Payer: Global Benefits Group Commercial |
$32.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$43.43
|
| Rate for Payer: Networks By Design Commercial |
$35.29
|
| Rate for Payer: Prime Health Services Commercial |
$46.15
|
|
|
HC SOM FLUOXETINE
|
Facility
|
OP
|
$54.29
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$10.86
|
| 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 |
$25.03
|
| Rate for Payer: Blue Shield of California Commercial |
$37.84
|
| Rate for Payer: Cash Price |
$54.29
|
| Rate for Payer: Cash Price |
$54.29
|
| Rate for Payer: Cigna of CA HMO |
$34.75
|
| Rate for Payer: Cigna of CA PPO |
$40.17
|
| 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 |
$38.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$46.15
|
| Rate for Payer: Global Benefits Group Commercial |
$32.57
|
| 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 |
$34.47
|
| 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 |
$13.03
|
| 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 |
$43.43
|
| Rate for Payer: Networks By Design Commercial |
$35.29
|
| Rate for Payer: Prime Health Services Commercial |
$46.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.57
|
| 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
|
|
