|
HC SOM LD ISOENZYMES
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.54
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.29
|
| Rate for Payer: Prime Health Services Commercial |
$9.54
|
|
|
HC SOM LD ISOENZYMES
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$131.89 |
| Rate for Payer: Cigna of CA PPO |
$8.30
|
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.89
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna of CA HMO |
$7.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.10
|
| Rate for Payer: EPIC Health Plan Senior |
$14.07
|
| Rate for Payer: Galaxy Health WC |
$9.54
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.29
|
| Rate for Payer: Prime Health Services Commercial |
$9.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.36
|
| Rate for Payer: United Healthcare All Other HMO |
$10.36
|
| Rate for Payer: United Healthcare HMO Rider |
$10.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Vantage Medical Group Senior |
$12.79
|
|
|
HC SOM LEAD BLOOD
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$124.94 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$4.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6.34
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.98
|
| Rate for Payer: EPIC Health Plan Senior |
$13.32
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM LEAD BLOOD
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC SOM LEAD URINE
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.98
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Multiplan Commercial |
$23.97
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
|
|
HC SOM LEAD URINE
|
Facility
|
OP
|
$29.96
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$124.94 |
| Rate for Payer: Cigna of CA PPO |
$22.17
|
| Rate for Payer: Adventist Health Commercial |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$13.81
|
| Rate for Payer: Blue Shield of California Commercial |
$20.88
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cigna of CA HMO |
$19.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.98
|
| Rate for Payer: EPIC Health Plan Senior |
$13.32
|
| Rate for Payer: Galaxy Health WC |
$25.47
|
| Rate for Payer: Global Benefits Group Commercial |
$17.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$23.97
|
| Rate for Payer: Networks By Design Commercial |
$19.47
|
| Rate for Payer: Prime Health Services Commercial |
$25.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$227.89 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$104.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.15
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM LEGIONELLA AB
|
Facility
|
OP
|
$22.71
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$155.66 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.66
|
| Rate for Payer: Blue Shield of California Commercial |
$10.47
|
| Rate for Payer: Blue Shield of California Commercial |
$15.83
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: Cigna of CA HMO |
$14.53
|
| Rate for Payer: Cigna of CA PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.25
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
|
|
HC SOM LEGIONELLA AB
|
Facility
|
IP
|
$22.71
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
|
IP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$13.66 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Senior |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
|
OP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Adventist Health Commercial |
$3.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.41
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cash Price |
$16.07
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$11.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.52
|
| Rate for Payer: EPIC Health Plan Senior |
$17.68
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$12.86
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC SOM LEGIONELLA PCR
|
Facility
|
IP
|
$57.50
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
900915470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$48.88 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23.00
|
| Rate for Payer: Galaxy Health WC |
$48.88
|
| Rate for Payer: Global Benefits Group Commercial |
$34.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Multiplan Commercial |
$46.00
|
| Rate for Payer: Networks By Design Commercial |
$37.38
|
| Rate for Payer: Prime Health Services Commercial |
$48.88
|
|
|
HC SOM LEGIONELLA PCR
|
Facility
|
OP
|
$57.50
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
900915470
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$583.71 |
| Rate for Payer: Adventist Health Commercial |
$11.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$583.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$362.04
|
| Rate for Payer: Blue Shield of California Commercial |
$26.51
|
| Rate for Payer: Blue Shield of California Commercial |
$40.08
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna of CA HMO |
$36.80
|
| Rate for Payer: Cigna of CA PPO |
$42.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.83
|
| Rate for Payer: EPIC Health Plan Senior |
$77.22
|
| Rate for Payer: Galaxy Health WC |
$48.88
|
| Rate for Payer: Global Benefits Group Commercial |
$34.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$115.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.07
|
| Rate for Payer: Multiplan Commercial |
$46.00
|
| Rate for Payer: Networks By Design Commercial |
$37.38
|
| Rate for Payer: Prime Health Services Commercial |
$48.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.86
|
| Rate for Payer: United Healthcare All Other HMO |
$56.86
|
| Rate for Payer: United Healthcare HMO Rider |
$56.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.22
|
| Rate for Payer: Vantage Medical Group Senior |
$70.20
|
|
|
HC SOM LEPTOSPIRA IGM
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM LEPTOSPIRA IGM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$109.71 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.67
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.73
|
| Rate for Payer: EPIC Health Plan Senior |
$17.82
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.71
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.12
|
| Rate for Payer: United Healthcare All Other HMO |
$13.12
|
| Rate for Payer: United Healthcare HMO Rider |
$13.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: Vantage Medical Group Senior |
$16.20
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| 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 |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| 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 |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.57
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| 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 |
$7.62
|
| 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 |
$2.88
|
| 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 |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| 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 LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM LIPASE BF
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$71.02 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.02
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$11.85
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Blue Shield of California Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.58
|
| Rate for Payer: EPIC Health Plan Senior |
$7.58
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPASE BF
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
|
OP
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$71.02 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.02
|
| Rate for Payer: Blue Shield of California Commercial |
$30.93
|
| Rate for Payer: Blue Shield of California Commercial |
$46.77
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cigna of CA HMO |
$42.94
|
| Rate for Payer: Cigna of CA PPO |
$49.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.37
|
| Rate for Payer: EPIC Health Plan Senior |
$7.58
|
| Rate for Payer: Galaxy Health WC |
$57.03
|
| Rate for Payer: Global Benefits Group Commercial |
$40.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$53.68
|
| Rate for Payer: Networks By Design Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$57.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
|
IP
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$57.03 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.84
|
| Rate for Payer: EPIC Health Plan Senior |
$26.84
|
| Rate for Payer: Galaxy Health WC |
$57.03
|
| Rate for Payer: Global Benefits Group Commercial |
$40.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.10
|
| Rate for Payer: Multiplan Commercial |
$53.68
|
| Rate for Payer: Networks By Design Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$57.03
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$130.71 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$8.36
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.63
|
| Rate for Payer: EPIC Health Plan Senior |
$15.75
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.60
|
| Rate for Payer: United Healthcare All Other HMO |
$11.60
|
| Rate for Payer: United Healthcare HMO Rider |
$11.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$222.92 |
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.92
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.56
|
| Rate for Payer: EPIC Health Plan Senior |
$17.04
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.76
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Vantage Medical Group Senior |
$15.49
|
|
