|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
IP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$104.89 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.36
|
| Rate for Payer: EPIC Health Plan Senior |
$49.36
|
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.62
|
| Rate for Payer: Multiplan Commercial |
$98.72
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
|
|
HC SOM PST
|
Facility
|
OP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$151.41 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.41
|
| Rate for Payer: Blue Shield of California Commercial |
$69.14
|
| Rate for Payer: Blue Shield of California EPN |
$45.68
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cigna of CA HMO |
$66.14
|
| Rate for Payer: Cigna of CA PPO |
$76.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$87.85
|
| Rate for Payer: Global Benefits Group Commercial |
$62.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$82.68
|
| Rate for Payer: Networks By Design Commercial |
$67.18
|
| Rate for Payer: Prime Health Services Commercial |
$87.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PST
|
Facility
|
IP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$87.85 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.34
|
| Rate for Payer: EPIC Health Plan Senior |
$41.34
|
| Rate for Payer: Galaxy Health WC |
$87.85
|
| Rate for Payer: Global Benefits Group Commercial |
$62.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$82.68
|
| Rate for Payer: Networks By Design Commercial |
$67.18
|
| Rate for Payer: Prime Health Services Commercial |
$87.85
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$139.58 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$10.45
|
| Rate for Payer: Blue Shield of California EPN |
$6.90
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$11.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Senior |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$12.50
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
IP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: EPIC Health Plan Senior |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$12.50
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
|
|
HC SOM PWDNA 81331
|
Facility
|
IP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$476.99 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.47
|
| Rate for Payer: EPIC Health Plan Senior |
$224.47
|
| Rate for Payer: Galaxy Health WC |
$476.99
|
| Rate for Payer: Global Benefits Group Commercial |
$336.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.68
|
| Rate for Payer: Multiplan Commercial |
$448.94
|
| Rate for Payer: Networks By Design Commercial |
$364.76
|
| Rate for Payer: Prime Health Services Commercial |
$476.99
|
|
|
HC SOM PWDNA 81331
|
Facility
|
OP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$476.99 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.07
|
| 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 |
$375.42
|
| Rate for Payer: Blue Shield of California EPN |
$248.04
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cigna of CA HMO |
$359.15
|
| Rate for Payer: Cigna of CA PPO |
$415.27
|
| 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 |
$476.99
|
| Rate for Payer: Global Benefits Group Commercial |
$336.70
|
| 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 |
$374.30
|
| 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 |
$134.68
|
| 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 |
$448.94
|
| Rate for Payer: Networks By Design Commercial |
$364.76
|
| Rate for Payer: Prime Health Services Commercial |
$476.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.70
|
| 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 PYRUVATE KINASE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$93.16 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.16
|
| Rate for Payer: Blue Shield of California Commercial |
$43.48
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.44
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.65
|
| Rate for Payer: United Healthcare HMO Rider |
$7.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.43
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Senior |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6.70
|
| Rate for Payer: Blue Shield of California EPN |
$4.43
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Senior |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
OP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Blue Shield of California EPN |
$4.43
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cigna of CA HMO |
$6.42
|
| Rate for Payer: Cigna of CA PPO |
$7.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Senior |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
IP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
OP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$124.68 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.68
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Blue Shield of California EPN |
$4.43
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: Cigna of CA HMO |
$6.42
|
| Rate for Payer: Cigna of CA PPO |
$7.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Senior |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
IP
|
$10.03
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Adventist Health Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$10.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.53
|
| Rate for Payer: Global Benefits Group Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.52
|
| Rate for Payer: Prime Health Services Commercial |
$8.53
|
|
|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$598.81 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.81
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.67
|
| Rate for Payer: EPIC Health Plan Senior |
$61.98
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.05
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.20
|
| Rate for Payer: United Healthcare All Other HMO |
$50.20
|
| Rate for Payer: United Healthcare HMO Rider |
$50.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$61.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Vantage Medical Group Senior |
$61.98
|
|
|
HC SOM RENIN ACT PLASMA
|
Facility
|
IP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.49
|
| Rate for Payer: EPIC Health Plan Senior |
$5.49
|
| Rate for Payer: Galaxy Health WC |
$11.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$10.98
|
| Rate for Payer: Networks By Design Commercial |
$8.92
|
| Rate for Payer: Prime Health Services Commercial |
$11.66
|
|
|
HC SOM RENIN ACT PLASMA
|
Facility
|
OP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$217.25 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.25
|
| Rate for Payer: Blue Shield of California Commercial |
$9.18
|
| Rate for Payer: Blue Shield of California EPN |
$6.06
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cigna of CA HMO |
$8.78
|
| Rate for Payer: Cigna of CA PPO |
$10.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.69
|
| Rate for Payer: EPIC Health Plan Senior |
$21.99
|
| Rate for Payer: Galaxy Health WC |
$11.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.47
|
| Rate for Payer: Multiplan Commercial |
$10.98
|
| Rate for Payer: Networks By Design Commercial |
$8.92
|
| Rate for Payer: Prime Health Services Commercial |
$11.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.81
|
| Rate for Payer: United Healthcare All Other HMO |
$17.81
|
| Rate for Payer: United Healthcare HMO Rider |
$17.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.99
|
|
|
HC SOM REPTILASE TIME
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.29
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.30
|
| Rate for Payer: EPIC Health Plan Senior |
$9.85
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.98
|
| Rate for Payer: United Healthcare All Other HMO |
$7.98
|
| Rate for Payer: United Healthcare HMO Rider |
$7.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Vantage Medical Group Senior |
$9.85
|
|
|
HC SOM REPTILASE TIME
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM RESPIRATORY PANEL VARIES
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
900915466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$1,396.84 |
| 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 |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,396.84
|
| 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 |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: EPIC Health Plan Senior |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$560.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| 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 |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC SOM RESPIRATORY PANEL VARIES
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 0202U
|
| Hospital Charge Code |
900915466
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
