|
HC SOM LYME DISEASE AB IGG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| 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
|
|
|
HC SOM LYME DISEASE AB IGM
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$222.92 |
| 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: Cigna of CA PPO |
$13.32
|
| 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
|
|
|
HC SOM LYME DISEASE AB IGM
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| 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
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
|
OP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$166.29 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7.51
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Cigna of CA HMO |
$10.43
|
| Rate for Payer: Cigna of CA PPO |
$12.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$13.04
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13.80
|
| Rate for Payer: United Healthcare HMO Rider |
$13.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
|
IP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$6.52
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$13.04
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Blue Shield of California Commercial |
$59.93
|
| Rate for Payer: Blue Shield of California Commercial |
$90.61
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
|
|
HC SOM LYSO 86003
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM LYSO 86003
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
|
OP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.72
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5.16
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$5.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$6.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$5.93
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
|
IP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Multiplan Commercial |
$5.93
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.30
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
|
IP
|
$25.03
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Adventist Health Commercial |
$5.01
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.01
|
| Rate for Payer: EPIC Health Plan Senior |
$10.01
|
| Rate for Payer: Galaxy Health WC |
$21.28
|
| Rate for Payer: Global Benefits Group Commercial |
$15.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$20.02
|
| Rate for Payer: Networks By Design Commercial |
$16.27
|
| Rate for Payer: Prime Health Services Commercial |
$21.28
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
|
OP
|
$25.03
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Adventist Health Commercial |
$5.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.72
|
| Rate for Payer: Blue Shield of California Commercial |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$17.45
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cigna of CA HMO |
$16.02
|
| Rate for Payer: Cigna of CA PPO |
$18.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$21.28
|
| Rate for Payer: Global Benefits Group Commercial |
$15.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$20.02
|
| Rate for Payer: Networks By Design Commercial |
$16.27
|
| Rate for Payer: Prime Health Services Commercial |
$21.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MANGANESE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM MANGANESE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$253.77 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.77
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.97
|
| Rate for Payer: EPIC Health Plan Senior |
$29.32
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.71
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.59
|
| Rate for Payer: United Healthcare All Other HMO |
$21.59
|
| Rate for Payer: United Healthcare HMO Rider |
$21.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Vantage Medical Group Senior |
$26.65
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$2,462.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,877.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,462.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.06
|
| Rate for Payer: Blue Shield of California Commercial |
$320.62
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.57
|
| Rate for Payer: EPIC Health Plan Senior |
$256.38
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$382.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$321.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$363.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$293.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$188.78
|
| Rate for Payer: United Healthcare HMO Rider |
$188.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$233.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC SOM MATRIX METALLOPROTEINASE 7
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| 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 |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$166.88
|
| Rate for Payer: Blue Shield of California Commercial |
$252.31
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna of CA HMO |
$231.68
|
| Rate for Payer: Cigna of CA PPO |
$267.88
|
| 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 |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.88
|
| 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 |
$289.60
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| 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 MATRIX METALLOPROTEINASE 7
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$307.70 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$213.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.88
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
|
IP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$43.64 |
| Rate for Payer: Adventist Health Commercial |
$10.27
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.54
|
| Rate for Payer: EPIC Health Plan Senior |
$20.54
|
| Rate for Payer: Galaxy Health WC |
$43.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$41.07
|
| Rate for Payer: Networks By Design Commercial |
$33.37
|
| Rate for Payer: Prime Health Services Commercial |
$43.64
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
|
OP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,751.12 |
| Rate for Payer: Cigna of CA PPO |
$37.99
|
| Rate for Payer: Adventist Health Commercial |
$10.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,751.12
|
| Rate for Payer: Blue Shield of California Commercial |
$23.67
|
| Rate for Payer: Blue Shield of California Commercial |
$35.78
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Cigna of CA HMO |
$32.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$43.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$41.07
|
| Rate for Payer: Networks By Design Commercial |
$33.37
|
| Rate for Payer: Prime Health Services Commercial |
$43.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
|
IP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.99
|
| Rate for Payer: EPIC Health Plan Senior |
$24.99
|
| Rate for Payer: Galaxy Health WC |
$53.10
|
| Rate for Payer: Global Benefits Group Commercial |
$37.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$49.98
|
| Rate for Payer: Networks By Design Commercial |
$40.61
|
| Rate for Payer: Prime Health Services Commercial |
$53.10
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
|
OP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$2,701.73 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$333.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,701.73
|
| Rate for Payer: Blue Shield of California Commercial |
$28.80
|
| Rate for Payer: Blue Shield of California Commercial |
$43.54
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Cigna of CA HMO |
$39.98
|
| Rate for Payer: Cigna of CA PPO |
$46.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$53.10
|
| Rate for Payer: Global Benefits Group Commercial |
$37.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$49.98
|
| Rate for Payer: Networks By Design Commercial |
$40.61
|
| Rate for Payer: Prime Health Services Commercial |
$53.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
|
IP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$22.26 |
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.29
|
| Rate for Payer: Multiplan Commercial |
$20.95
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
|
OP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$192.83 |
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.83
|
| Rate for Payer: Blue Shield of California Commercial |
$18.25
|
| Rate for Payer: Blue Shield of California Commercial |
$12.07
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$19.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$20.95
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.26
|
| Rate for Payer: Vantage Medical Group Senior |
$22.26
|
|
