|
HC SOM FQUET 82491
|
Facility
|
IP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.46
|
| Rate for Payer: EPIC Health Plan Senior |
$26.46
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.88
|
| Rate for Payer: Multiplan Commercial |
$52.93
|
| Rate for Payer: Networks By Design Commercial |
$43.00
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
|
|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
|
OP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$202.91 |
| Rate for Payer: Adventist Health Commercial |
$43.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.91
|
| Rate for Payer: Blue Shield of California Commercial |
$150.90
|
| Rate for Payer: Blue Shield of California Commercial |
$99.81
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cigna of CA HMO |
$138.56
|
| Rate for Payer: Cigna of CA PPO |
$160.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.07
|
| Rate for Payer: EPIC Health Plan Senior |
$49.38
|
| Rate for Payer: Galaxy Health WC |
$184.03
|
| Rate for Payer: Global Benefits Group Commercial |
$129.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$73.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$173.20
|
| Rate for Payer: Networks By Design Commercial |
$140.72
|
| Rate for Payer: Prime Health Services Commercial |
$184.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.36
|
| Rate for Payer: United Healthcare All Other HMO |
$36.36
|
| Rate for Payer: United Healthcare HMO Rider |
$36.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$44.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Vantage Medical Group Senior |
$44.89
|
|
|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
|
IP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$184.03 |
| Rate for Payer: Adventist Health Commercial |
$43.30
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.60
|
| Rate for Payer: EPIC Health Plan Senior |
$86.60
|
| Rate for Payer: Galaxy Health WC |
$184.03
|
| Rate for Payer: Global Benefits Group Commercial |
$129.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.96
|
| Rate for Payer: Multiplan Commercial |
$173.20
|
| Rate for Payer: Networks By Design Commercial |
$140.72
|
| Rate for Payer: Prime Health Services Commercial |
$184.03
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
|
IP
|
$299.72
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$254.76 |
| Rate for Payer: Adventist Health Commercial |
$59.94
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$209.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.89
|
| Rate for Payer: EPIC Health Plan Senior |
$119.89
|
| Rate for Payer: Galaxy Health WC |
$254.76
|
| Rate for Payer: Global Benefits Group Commercial |
$179.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$176.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.93
|
| Rate for Payer: Multiplan Commercial |
$239.78
|
| Rate for Payer: Networks By Design Commercial |
$194.82
|
| Rate for Payer: Prime Health Services Commercial |
$254.76
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
|
OP
|
$299.72
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$505.12 |
| Rate for Payer: Adventist Health Commercial |
$59.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$367.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$505.12
|
| Rate for Payer: Blue Shield of California Commercial |
$138.17
|
| Rate for Payer: Blue Shield of California Commercial |
$208.90
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Cigna of CA HMO |
$191.82
|
| Rate for Payer: Cigna of CA PPO |
$221.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$209.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.12
|
| Rate for Payer: EPIC Health Plan Senior |
$62.74
|
| Rate for Payer: Galaxy Health WC |
$254.76
|
| Rate for Payer: Global Benefits Group Commercial |
$179.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$93.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.43
|
| Rate for Payer: Multiplan Commercial |
$239.78
|
| Rate for Payer: Networks By Design Commercial |
$194.82
|
| Rate for Payer: Prime Health Services Commercial |
$254.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$179.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$179.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.21
|
| Rate for Payer: United Healthcare All Other HMO |
$46.21
|
| Rate for Payer: United Healthcare HMO Rider |
$46.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$57.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Vantage Medical Group Senior |
$57.04
|
|
|
HC SOM FRANSICELLA AB
|
Facility
|
IP
|
$52.25
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Adventist Health Commercial |
$10.45
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Senior |
$20.90
|
| Rate for Payer: Galaxy Health WC |
$44.41
|
| Rate for Payer: Global Benefits Group Commercial |
$31.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.54
|
| Rate for Payer: Multiplan Commercial |
$41.80
|
| Rate for Payer: Networks By Design Commercial |
$33.96
|
| Rate for Payer: Prime Health Services Commercial |
$44.41
|
|
|
HC SOM FRANSICELLA AB
|
Facility
|
OP
|
$52.25
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$65.04 |
| Rate for Payer: Adventist Health Commercial |
$10.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.04
|
| Rate for Payer: Blue Shield of California Commercial |
$24.09
|
| Rate for Payer: Blue Shield of California Commercial |
$36.42
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Cash Price |
$52.25
|
| Rate for Payer: Cigna of CA HMO |
$33.44
|
| Rate for Payer: Cigna of CA PPO |
$38.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$44.41
|
| Rate for Payer: Global Benefits Group Commercial |
$31.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$41.80
|
| Rate for Payer: Networks By Design Commercial |
$33.96
|
| Rate for Payer: Prime Health Services Commercial |
$44.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC SOM FREE FATTY ACIDS
|
Facility
|
IP
|
$39.05
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$33.19 |
| Rate for Payer: Adventist Health Commercial |
$7.81
|
| Rate for Payer: Cash Price |
$39.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.62
|
| Rate for Payer: EPIC Health Plan Senior |
$15.62
|
| Rate for Payer: Galaxy Health WC |
$33.19
|
| Rate for Payer: Global Benefits Group Commercial |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.37
|
| Rate for Payer: Multiplan Commercial |
$31.24
|
| Rate for Payer: Networks By Design Commercial |
$25.38
|
| Rate for Payer: Prime Health Services Commercial |
$33.19
|
|
|
HC SOM FREE FATTY ACIDS
|
Facility
|
OP
|
$39.05
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$137.45 |
| Rate for Payer: Adventist Health Commercial |
$7.81
|
| 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 |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.22
|
| Rate for Payer: Cash Price |
$39.05
|
| Rate for Payer: Cash Price |
$39.05
|
| Rate for Payer: Cigna of CA HMO |
$24.99
|
| Rate for Payer: Cigna of CA PPO |
$28.90
|
| 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 |
$27.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Senior |
$20.65
|
| Rate for Payer: Galaxy Health WC |
$33.19
|
| Rate for Payer: Global Benefits Group Commercial |
$23.43
|
| 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 |
$24.80
|
| 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 |
$9.37
|
| 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 |
$31.24
|
| Rate for Payer: Networks By Design Commercial |
$25.38
|
| Rate for Payer: Prime Health Services Commercial |
$33.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.43
|
| 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 FR TYR IDX BIND CAP
|
Facility
|
OP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Cigna of CA HMO |
$5.93
|
| Rate for Payer: Cigna of CA PPO |
$6.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$7.88
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM FR TYR IDX BIND CAP
|
Facility
|
IP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Adventist Health Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.88
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.88
|
|
|
HC SOM FRUCTOSAMINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
900913929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.65
|
| Rate for Payer: EPIC Health Plan Senior |
$18.44
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.46
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.57
|
| Rate for Payer: United Healthcare All Other HMO |
$13.57
|
| Rate for Payer: United Healthcare HMO Rider |
$13.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16.76
|
|
|
HC SOM FRUCTOSAMINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
900913929
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM FSUCC 82491
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$128.94
|
| Rate for Payer: Blue Shield of California Commercial |
$85.28
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FSUCC 82491
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914734
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC SOM FUNGITELL
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900915351
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SOM FUNGITELL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900915351
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Adventist Health Commercial |
$29.20
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$33.19
|
| Rate for Payer: Blue Shield of California Commercial |
$101.76
|
| Rate for Payer: Blue Shield of California Commercial |
$50.18
|
| Rate for Payer: Blue Shield of California Commercial |
$67.31
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$102.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM FUNGITELL ASSAY
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900912985
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC SOM FUNGITELL ASSAY
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900912985
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$59.93
|
| Rate for Payer: Blue Shield of California Commercial |
$90.61
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM GABAPENTIN (NEURONTIN)
|
Facility
|
IP
|
$22.35
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
900910415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Cash Price |
$22.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.94
|
| Rate for Payer: Galaxy Health WC |
$19.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$17.88
|
| Rate for Payer: Networks By Design Commercial |
$14.53
|
| Rate for Payer: Prime Health Services Commercial |
$19.00
|
|
|
HC SOM GABAPENTIN (NEURONTIN)
|
Facility
|
OP
|
$22.35
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
900910415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: Adventist Health Commercial |
$4.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.27
|
| Rate for Payer: Blue Shield of California Commercial |
$10.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.58
|
| Rate for Payer: Cash Price |
$22.35
|
| Rate for Payer: Cash Price |
$22.35
|
| Rate for Payer: Cigna of CA HMO |
$14.30
|
| Rate for Payer: Cigna of CA PPO |
$16.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.76
|
| Rate for Payer: EPIC Health Plan Senior |
$23.84
|
| Rate for Payer: Galaxy Health WC |
$19.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$17.88
|
| Rate for Payer: Networks By Design Commercial |
$14.53
|
| Rate for Payer: Prime Health Services Commercial |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.55
|
| Rate for Payer: United Healthcare All Other HMO |
$17.55
|
| Rate for Payer: United Healthcare HMO Rider |
$17.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.84
|
| Rate for Payer: Vantage Medical Group Senior |
$21.67
|
|
|
HC SOM GAD 65 ANTIBODIES
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900912683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Senior |
$17.48
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$34.95
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
|
|
HC SOM GAD 65 ANTIBODIES
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900912683
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$158.71 |
| Rate for Payer: Cigna of CA PPO |
$32.33
|
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.71
|
| Rate for Payer: Blue Shield of California Commercial |
$20.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.45
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cigna of CA HMO |
$27.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$34.95
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM GAL-1-PO4 URIDYL TR
|
Facility
|
IP
|
$61.34
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
900911057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$52.14 |
| Rate for Payer: Adventist Health Commercial |
$12.27
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.54
|
| Rate for Payer: EPIC Health Plan Senior |
$24.54
|
| Rate for Payer: Galaxy Health WC |
$52.14
|
| Rate for Payer: Global Benefits Group Commercial |
$36.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.72
|
| Rate for Payer: Multiplan Commercial |
$49.07
|
| Rate for Payer: Networks By Design Commercial |
$39.87
|
| Rate for Payer: Prime Health Services Commercial |
$52.14
|
|
|
HC SOM GAL-1-PO4 URIDYL TR
|
Facility
|
OP
|
$61.34
|
|
|
Service Code
|
CPT 82775
|
| Hospital Charge Code |
900911057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Adventist Health Commercial |
$12.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.50
|
| Rate for Payer: Blue Shield of California Commercial |
$28.28
|
| Rate for Payer: Blue Shield of California Commercial |
$42.75
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cigna of CA HMO |
$39.26
|
| Rate for Payer: Cigna of CA PPO |
$45.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.77
|
| Rate for Payer: EPIC Health Plan Senior |
$23.18
|
| Rate for Payer: Galaxy Health WC |
$52.14
|
| Rate for Payer: Global Benefits Group Commercial |
$36.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.23
|
| Rate for Payer: Multiplan Commercial |
$49.07
|
| Rate for Payer: Networks By Design Commercial |
$39.87
|
| Rate for Payer: Prime Health Services Commercial |
$52.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.06
|
| Rate for Payer: United Healthcare All Other HMO |
$17.06
|
| Rate for Payer: United Healthcare HMO Rider |
$17.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.18
|
| Rate for Payer: Vantage Medical Group Senior |
$21.07
|
|
