|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
IP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.38
|
| Rate for Payer: EPIC Health Plan Senior |
$102.38
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.43
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
OP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$527.39 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.39
|
| Rate for Payer: Blue Shield of California Commercial |
$171.22
|
| Rate for Payer: Blue Shield of California EPN |
$113.13
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cigna of CA HMO |
$163.80
|
| Rate for Payer: Cigna of CA PPO |
$189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.87
|
| Rate for Payer: EPIC Health Plan Senior |
$207.31
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$277.80
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.92
|
| Rate for Payer: United Healthcare All Other HMO |
$167.92
|
| Rate for Payer: United Healthcare HMO Rider |
$167.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$207.31
|
|
|
HC SOM PNEUMOCYSTIS PCR
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$74.93
|
| Rate for Payer: Blue Shield of California EPN |
$49.50
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM PNEUMOCYSTIS PCR
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$83.45 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.45
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Senior |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
|
IP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.43
|
| Rate for Payer: EPIC Health Plan Senior |
$8.43
|
| Rate for Payer: Galaxy Health WC |
$17.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.06
|
| Rate for Payer: Multiplan Commercial |
$16.86
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: Prime Health Services Commercial |
$17.92
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
|
OP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$145.30 |
| Rate for Payer: Adventist Health Commercial |
$4.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.30
|
| Rate for Payer: Blue Shield of California Commercial |
$14.10
|
| Rate for Payer: Blue Shield of California EPN |
$9.32
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cash Price |
$21.08
|
| Rate for Payer: Cigna of CA HMO |
$13.49
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.71
|
| Rate for Payer: Galaxy Health WC |
$17.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.71
|
| Rate for Payer: Multiplan Commercial |
$16.86
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: Prime Health Services Commercial |
$17.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
|
OP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$83.45 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.45
|
| Rate for Payer: Blue Shield of California Commercial |
$8.09
|
| Rate for Payer: Blue Shield of California EPN |
$5.34
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$8.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Senior |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$10.28
|
| Rate for Payer: Global Benefits Group Commercial |
$7.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$9.67
|
| Rate for Payer: Networks By Design Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$10.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
|
IP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Adventist Health Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.84
|
| Rate for Payer: EPIC Health Plan Senior |
$4.84
|
| Rate for Payer: Galaxy Health WC |
$10.28
|
| Rate for Payer: Global Benefits Group Commercial |
$7.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$9.67
|
| Rate for Payer: Networks By Design Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$10.28
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$69.09 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.09
|
| Rate for Payer: Blue Shield of California Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
OP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$145.30 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.30
|
| Rate for Payer: Blue Shield of California Commercial |
$19.13
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: Cigna of CA HMO |
$18.30
|
| Rate for Payer: Cigna of CA PPO |
$21.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.71
|
| Rate for Payer: Galaxy Health WC |
$24.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.71
|
| Rate for Payer: Multiplan Commercial |
$22.87
|
| Rate for Payer: Networks By Design Commercial |
$18.58
|
| Rate for Payer: Prime Health Services Commercial |
$24.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
IP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$24.30 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$28.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.44
|
| Rate for Payer: EPIC Health Plan Senior |
$11.44
|
| Rate for Payer: Galaxy Health WC |
$24.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$22.87
|
| Rate for Payer: Networks By Design Commercial |
$18.58
|
| Rate for Payer: Prime Health Services Commercial |
$24.30
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
IP
|
$16.41
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$16.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.56
|
| Rate for Payer: EPIC Health Plan Senior |
$6.56
|
| Rate for Payer: Galaxy Health WC |
$13.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$13.13
|
| Rate for Payer: Networks By Design Commercial |
$10.67
|
| Rate for Payer: Prime Health Services Commercial |
$13.95
|
|
|
HC SOM PORPHYR UR FRAC PORPHOBIL
|
Facility
|
OP
|
$16.41
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$83.45 |
| Rate for Payer: Adventist Health Commercial |
$3.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$7.25
|
| Rate for Payer: Cash Price |
$16.41
|
| Rate for Payer: Cash Price |
$16.41
|
| Rate for Payer: Cigna of CA HMO |
$10.50
|
| Rate for Payer: Cigna of CA PPO |
$12.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Senior |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$13.95
|
| Rate for Payer: Global Benefits Group Commercial |
$9.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$13.13
|
| Rate for Payer: Networks By Design Commercial |
$10.67
|
| Rate for Payer: Prime Health Services Commercial |
$13.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$94.89 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.89
|
| Rate for Payer: Blue Shield of California Commercial |
$18.14
|
| Rate for Payer: Blue Shield of California EPN |
$11.98
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.11
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$21.69
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM POSACONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80187
|
| Hospital Charge Code |
900912708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$21.69
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$397.98 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$397.98
|
| Rate for Payer: Blue Shield of California Commercial |
$234.15
|
| Rate for Payer: Blue Shield of California EPN |
$154.70
|
| 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 |
$76.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.94
|
| Rate for Payer: EPIC Health Plan Senior |
$51.07
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$83.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.43
|
| 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 |
$41.36
|
| Rate for Payer: United Healthcare All Other HMO |
$41.36
|
| Rate for Payer: United Healthcare HMO Rider |
$41.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PRADER WILLI SYNDROME ANALYSIS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900910668
|
|
Hospital Revenue Code
|
301
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 PREGNENOLONE, SERUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM PREGNENOLONE, SERUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
900915512
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$199.82 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.82
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.90
|
| Rate for Payer: EPIC Health Plan Senior |
$20.67
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.70
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.74
|
| Rate for Payer: United Healthcare All Other HMO |
$16.74
|
| Rate for Payer: United Healthcare HMO Rider |
$16.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.74
|
| Rate for Payer: Vantage Medical Group Senior |
$20.67
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$163.98 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.98
|
| Rate for Payer: Blue Shield of California Commercial |
$17.40
|
| Rate for Payer: Blue Shield of California EPN |
$11.50
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Cigna of CA HMO |
$16.65
|
| Rate for Payer: Cigna of CA PPO |
$19.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$22.11
|
| Rate for Payer: Global Benefits Group Commercial |
$15.61
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.23
|
| Rate for Payer: Multiplan Commercial |
$20.81
|
| Rate for Payer: Networks By Design Commercial |
$16.91
|
| Rate for Payer: Prime Health Services Commercial |
$22.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.44
|
| Rate for Payer: United Healthcare All Other HMO |
$13.44
|
| Rate for Payer: United Healthcare HMO Rider |
$13.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.25
|
| Rate for Payer: Vantage Medical Group Senior |
$16.59
|
|
|
HC SOM PRIMIDONE LEVEL
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
900911489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.11
|
| Rate for Payer: Global Benefits Group Commercial |
$15.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$20.81
|
| Rate for Payer: Networks By Design Commercial |
$16.91
|
| Rate for Payer: Prime Health Services Commercial |
$22.11
|
|
