|
HC SOM INTRINSIC FACTOR BLOCKING AB
|
Facility
|
OP
|
$23.15
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
900911094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cigna of CA HMO |
$14.82
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.88
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$19.68
|
| Rate for Payer: Global Benefits Group Commercial |
$13.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$18.52
|
| Rate for Payer: Networks By Design Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$19.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM IRON LIVER TISSUE
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$66.85 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| 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 |
$66.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6.47
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cigna of CA HMO |
$5.94
|
| Rate for Payer: Cigna of CA PPO |
$6.87
|
| 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 |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.61
|
| 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 |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| 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 |
$7.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| 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 IRON LIVER TISSUE
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: EPIC Health Plan Senior |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.23
|
| Rate for Payer: Multiplan Commercial |
$7.42
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
|
|
HC SOM ITRACONAZOLE LEVEL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| 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 ITRACONAZOLE LEVEL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80189
|
| Hospital Charge Code |
900911379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$160.18 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.18
|
| 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 |
$99.16
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| 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 |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.73
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| 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 |
$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 |
$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 JAK 2 V617F MUTATION
|
Facility
|
IP
|
$214.37
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$182.21 |
| Rate for Payer: Galaxy Health WC |
$182.21
|
| Rate for Payer: Adventist Health Commercial |
$42.87
|
| Rate for Payer: Cash Price |
$214.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.75
|
| Rate for Payer: EPIC Health Plan Senior |
$85.75
|
| Rate for Payer: Global Benefits Group Commercial |
$128.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$171.50
|
| Rate for Payer: Networks By Design Commercial |
$139.34
|
| Rate for Payer: Prime Health Services Commercial |
$182.21
|
|
|
HC SOM JAK 2 V617F MUTATION
|
Facility
|
OP
|
$214.37
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$42.87 |
| Max. Negotiated Rate |
$499.14 |
| Rate for Payer: Adventist Health Commercial |
$42.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.14
|
| Rate for Payer: Blue Shield of California Commercial |
$149.42
|
| Rate for Payer: Blue Shield of California Commercial |
$98.82
|
| Rate for Payer: Cash Price |
$214.37
|
| Rate for Payer: Cash Price |
$214.37
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$158.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.24
|
| Rate for Payer: EPIC Health Plan Senior |
$100.83
|
| Rate for Payer: Galaxy Health WC |
$182.21
|
| Rate for Payer: Global Benefits Group Commercial |
$128.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$150.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$111.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122.82
|
| Rate for Payer: Multiplan Commercial |
$171.50
|
| Rate for Payer: Networks By Design Commercial |
$139.34
|
| Rate for Payer: Prime Health Services Commercial |
$182.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.24
|
| Rate for Payer: United Healthcare All Other HMO |
$74.24
|
| Rate for Payer: United Healthcare HMO Rider |
$74.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$91.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$33.19
|
| Rate for Payer: Blue Shield of California Commercial |
$50.18
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| 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 |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| 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 JC VIRUS BY PCR
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| 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 KAPPA LIGHT CHAINS
|
Facility
|
IP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.36
|
| Rate for Payer: EPIC Health Plan Senior |
$5.36
|
| Rate for Payer: Galaxy Health WC |
$11.38
|
| Rate for Payer: Global Benefits Group Commercial |
$8.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
| Rate for Payer: Networks By Design Commercial |
$8.70
|
| Rate for Payer: Prime Health Services Commercial |
$11.38
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
|
OP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.17
|
| Rate for Payer: Blue Shield of California Commercial |
$9.33
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cigna of CA HMO |
$8.57
|
| Rate for Payer: Cigna of CA PPO |
$9.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$11.38
|
| Rate for Payer: Global Benefits Group Commercial |
$8.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
| Rate for Payer: Networks By Design Commercial |
$8.70
|
| Rate for Payer: Prime Health Services Commercial |
$11.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$259.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208.71
|
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.05
|
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna of CA HMO |
$4.80
|
| Rate for Payer: Cigna of CA PPO |
$5.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.23
|
| Rate for Payer: EPIC Health Plan Senior |
$36.82
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$54.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.80
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
|
|
HC SOM KPNRP 87798
|
Facility
|
OP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$110.09
|
| Rate for Payer: Blue Shield of California Commercial |
$72.81
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cigna of CA HMO |
$101.09
|
| Rate for Payer: Cigna of CA PPO |
$116.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$134.26
|
| Rate for Payer: Global Benefits Group Commercial |
$94.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$100.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.91
|
| 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 |
$126.36
|
| Rate for Payer: Networks By Design Commercial |
$102.67
|
| Rate for Payer: Prime Health Services Commercial |
$134.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.77
|
| 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 KPNRP 87798
|
Facility
|
IP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$134.26 |
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.18
|
| Rate for Payer: EPIC Health Plan Senior |
$63.18
|
| Rate for Payer: Galaxy Health WC |
$134.26
|
| Rate for Payer: Global Benefits Group Commercial |
$94.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.91
|
| Rate for Payer: Multiplan Commercial |
$126.36
|
| Rate for Payer: Networks By Design Commercial |
$102.67
|
| Rate for Payer: Prime Health Services Commercial |
$134.26
|
|
|
HC SOM LACTOFERR DET EIA STOOL
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Senior |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$62.54
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
|
|
HC SOM LACTOFERR DET EIA STOOL
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$163.24 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.95
|
| Rate for Payer: Blue Shield of California Commercial |
$44.36
|
| Rate for Payer: Blue Shield of California Commercial |
$67.07
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$71.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.51
|
| Rate for Payer: EPIC Health Plan Senior |
$21.67
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$76.98
|
| Rate for Payer: Networks By Design Commercial |
$62.54
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.96
|
| Rate for Payer: United Healthcare All Other HMO |
$15.96
|
| Rate for Payer: United Healthcare HMO Rider |
$15.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Vantage Medical Group Senior |
$19.70
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
OP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.17
|
| Rate for Payer: Blue Shield of California Commercial |
$9.33
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cigna of CA HMO |
$8.57
|
| Rate for Payer: Cigna of CA PPO |
$9.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$11.38
|
| Rate for Payer: Global Benefits Group Commercial |
$8.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
| Rate for Payer: Networks By Design Commercial |
$8.70
|
| Rate for Payer: Prime Health Services Commercial |
$11.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
IP
|
$13.39
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Adventist Health Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.36
|
| Rate for Payer: EPIC Health Plan Senior |
$5.36
|
| Rate for Payer: Galaxy Health WC |
$11.38
|
| Rate for Payer: Global Benefits Group Commercial |
$8.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$10.71
|
| Rate for Payer: Networks By Design Commercial |
$8.70
|
| Rate for Payer: Prime Health Services Commercial |
$11.38
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
|
IP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: EPIC Health Plan Senior |
$5.73
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$11.46
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
|
OP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.98
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$9.16
|
| Rate for Payer: Cigna of CA PPO |
$10.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.57
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$11.46
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LASIX
|
Facility
|
IP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$101.39 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.71
|
| Rate for Payer: EPIC Health Plan Senior |
$47.71
|
| Rate for Payer: Galaxy Health WC |
$101.39
|
| Rate for Payer: Global Benefits Group Commercial |
$71.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.63
|
| Rate for Payer: Multiplan Commercial |
$95.42
|
| Rate for Payer: Networks By Design Commercial |
$77.53
|
| Rate for Payer: Prime Health Services Commercial |
$101.39
|
|
|
HC SOM LASIX
|
Facility
|
OP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$54.99
|
| Rate for Payer: Blue Shield of California Commercial |
$83.14
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cigna of CA HMO |
$76.34
|
| Rate for Payer: Cigna of CA PPO |
$88.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$101.39
|
| Rate for Payer: Global Benefits Group Commercial |
$71.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$95.42
|
| Rate for Payer: Networks By Design Commercial |
$77.53
|
| Rate for Payer: Prime Health Services Commercial |
$101.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$62.12 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.12
|
| Rate for Payer: Blue Shield of California Commercial |
$5.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.97
|
| Rate for Payer: EPIC Health Plan Senior |
$6.64
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
