|
HC SOM STREP PNEUMO SEROTYPE 9V (68)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$148.09 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| 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 |
$148.09
|
| Rate for Payer: Blue Shield of California Commercial |
$3.35
|
| Rate for Payer: Blue Shield of California EPN |
$2.21
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| 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: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| 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 |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM STREP PNEUMO SEROTYPE 9V (68)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900912866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC SOM STREPTOCOCCAL ABS
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
900911155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$130.87 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.50
|
| 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 |
$130.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.63
|
| Rate for Payer: Blue Shield of California EPN |
$4.38
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cigna of CA HMO |
$6.34
|
| Rate for Payer: Cigna of CA PPO |
$7.33
|
| 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: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| 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 |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| 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 STREPTOCOCCAL ABS
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
900911155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.96
|
| Rate for Payer: EPIC Health Plan Senior |
$3.96
|
| Rate for Payer: Galaxy Health WC |
$8.42
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.38
|
| Rate for Payer: Multiplan Commercial |
$7.93
|
| Rate for Payer: Networks By Design Commercial |
$6.44
|
| Rate for Payer: Prime Health Services Commercial |
$8.42
|
|
|
HC SOM STREPTOCOCCAL ABS, SNTISTREP-O
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
900912820
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM STREPTOCOCCAL ABS, SNTISTREP-O
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
900912820
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$72.08 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.86
|
| Rate for Payer: EPIC Health Plan Senior |
$7.30
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Vantage Medical Group Senior |
$7.30
|
|
|
HC SOM SULFA DRUGS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SULFA DRUGS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM TAPENTADOL URINE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$191.78 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.78
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC SOM TAPENTADOL URINE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM TCP 86359
|
Facility
|
IP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$98.05 |
| Rate for Payer: Adventist Health Commercial |
$23.07
|
| Rate for Payer: Cash Price |
$115.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.14
|
| Rate for Payer: EPIC Health Plan Senior |
$46.14
|
| Rate for Payer: Galaxy Health WC |
$98.05
|
| Rate for Payer: Global Benefits Group Commercial |
$69.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.68
|
| Rate for Payer: Multiplan Commercial |
$92.28
|
| Rate for Payer: Networks By Design Commercial |
$74.98
|
| Rate for Payer: Prime Health Services Commercial |
$98.05
|
|
|
HC SOM TCP 86359
|
Facility
|
OP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$373.25 |
| Rate for Payer: Adventist Health Commercial |
$23.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.25
|
| Rate for Payer: Blue Shield of California Commercial |
$77.17
|
| Rate for Payer: Blue Shield of California EPN |
$50.98
|
| Rate for Payer: Cash Price |
$115.35
|
| Rate for Payer: Cash Price |
$115.35
|
| Rate for Payer: Cigna of CA HMO |
$73.82
|
| Rate for Payer: Cigna of CA PPO |
$85.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$98.05
|
| Rate for Payer: Global Benefits Group Commercial |
$69.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$92.28
|
| Rate for Payer: Networks By Design Commercial |
$74.98
|
| Rate for Payer: Prime Health Services Commercial |
$98.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM TCP 86361
|
Facility
|
OP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$265.99 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.99
|
| Rate for Payer: Blue Shield of California Commercial |
$54.77
|
| Rate for Payer: Blue Shield of California EPN |
$36.19
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: Cigna of CA HMO |
$52.40
|
| Rate for Payer: Cigna of CA PPO |
$60.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Senior |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$69.59
|
| Rate for Payer: Global Benefits Group Commercial |
$49.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$65.50
|
| Rate for Payer: Networks By Design Commercial |
$53.22
|
| Rate for Payer: Prime Health Services Commercial |
$69.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC SOM TCP 86361
|
Facility
|
IP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$69.59 |
| Rate for Payer: Adventist Health Commercial |
$16.37
|
| Rate for Payer: Cash Price |
$81.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.75
|
| Rate for Payer: EPIC Health Plan Senior |
$32.75
|
| Rate for Payer: Galaxy Health WC |
$69.59
|
| Rate for Payer: Global Benefits Group Commercial |
$49.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.65
|
| Rate for Payer: Multiplan Commercial |
$65.50
|
| Rate for Payer: Networks By Design Commercial |
$53.22
|
| Rate for Payer: Prime Health Services Commercial |
$69.59
|
|
|
HC SOM TCP 88184
|
Facility
|
IP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$169.47 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.75
|
| Rate for Payer: EPIC Health Plan Senior |
$79.75
|
| Rate for Payer: Galaxy Health WC |
$169.47
|
| Rate for Payer: Global Benefits Group Commercial |
$119.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.85
|
| Rate for Payer: Multiplan Commercial |
$159.50
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.47
|
|
|
HC SOM TCP 88184
|
Facility
|
OP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$39.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$133.39
|
| Rate for Payer: Blue Shield of California EPN |
$88.13
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Cash Price |
$199.38
|
| Rate for Payer: Cigna of CA HMO |
$127.60
|
| Rate for Payer: Cigna of CA PPO |
$147.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$169.47
|
| Rate for Payer: Global Benefits Group Commercial |
$119.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$159.50
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
|
OP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$256.88 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.88
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.95
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cigna of CA HMO |
$5.72
|
| Rate for Payer: Cigna of CA PPO |
$6.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.38
|
| Rate for Payer: EPIC Health Plan Senior |
$25.47
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$7.15
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.63
|
| Rate for Payer: United Healthcare All Other HMO |
$20.63
|
| Rate for Payer: United Healthcare HMO Rider |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
|
IP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Adventist Health Commercial |
$1.79
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: EPIC Health Plan Senior |
$3.58
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$7.15
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
|
OP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$148.09 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.39
|
| 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 |
$148.09
|
| Rate for Payer: Blue Shield of California Commercial |
$13.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.03
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cigna of CA HMO |
$13.07
|
| Rate for Payer: Cigna of CA PPO |
$15.11
|
| 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: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$17.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 |
$13.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| 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 |
$16.34
|
| Rate for Payer: Networks By Design Commercial |
$13.27
|
| Rate for Payer: Prime Health Services Commercial |
$17.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.25
|
| 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
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
|
IP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$17.36 |
| Rate for Payer: Adventist Health Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.17
|
| Rate for Payer: EPIC Health Plan Senior |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$17.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.90
|
| Rate for Payer: Multiplan Commercial |
$16.34
|
| Rate for Payer: Networks By Design Commercial |
$13.27
|
| Rate for Payer: Prime Health Services Commercial |
$17.36
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$272.50 |
| Max. Negotiated Rate |
$1,158.12 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$545.00
|
| Rate for Payer: EPIC Health Plan Senior |
$545.00
|
| Rate for Payer: Galaxy Health WC |
$1,158.12
|
| Rate for Payer: Global Benefits Group Commercial |
$817.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$519.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.00
|
| Rate for Payer: Multiplan Commercial |
$1,090.00
|
| Rate for Payer: Networks By Design Commercial |
$885.62
|
| Rate for Payer: Prime Health Services Commercial |
$1,158.12
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
|
OP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.01 |
| Max. Negotiated Rate |
$1,478.16 |
| Rate for Payer: Adventist Health Commercial |
$272.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$893.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,478.16
|
| Rate for Payer: Blue Shield of California Commercial |
$911.51
|
| Rate for Payer: Blue Shield of California EPN |
$602.23
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cigna of CA HMO |
$872.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$203.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Senior |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$1,158.12
|
| Rate for Payer: Global Benefits Group Commercial |
$817.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$303.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$185.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$1,090.00
|
| Rate for Payer: Networks By Design Commercial |
$885.62
|
| Rate for Payer: Prime Health Services Commercial |
$1,158.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$817.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$817.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$185.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM THALLIUM URINE
|
Facility
|
IP
|
$217.26
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$184.67 |
| Rate for Payer: Adventist Health Commercial |
$43.45
|
| Rate for Payer: Cash Price |
$217.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.90
|
| Rate for Payer: EPIC Health Plan Senior |
$86.90
|
| Rate for Payer: Galaxy Health WC |
$184.67
|
| Rate for Payer: Global Benefits Group Commercial |
$130.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.14
|
| Rate for Payer: Multiplan Commercial |
$173.81
|
| Rate for Payer: Networks By Design Commercial |
$141.22
|
| Rate for Payer: Prime Health Services Commercial |
$184.67
|
|
|
HC SOM THALLIUM URINE
|
Facility
|
OP
|
$217.26
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$184.67 |
| Rate for Payer: Adventist Health Commercial |
$43.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.06
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$96.03
|
| Rate for Payer: Cash Price |
$217.26
|
| Rate for Payer: Cash Price |
$217.26
|
| Rate for Payer: Cigna of CA HMO |
$139.05
|
| Rate for Payer: Cigna of CA PPO |
$160.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.96
|
| Rate for Payer: Galaxy Health WC |
$184.67
|
| Rate for Payer: Global Benefits Group Commercial |
$130.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$173.81
|
| Rate for Payer: Networks By Design Commercial |
$141.22
|
| Rate for Payer: Prime Health Services Commercial |
$184.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.78
|
| Rate for Payer: United Healthcare All Other HMO |
$17.78
|
| Rate for Payer: United Healthcare HMO Rider |
$17.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM THC CONFIRMATION, U
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912921
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$224.43 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.43
|
| Rate for Payer: Blue Shield of California Commercial |
$21.14
|
| Rate for Payer: Blue Shield of California EPN |
$13.97
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cigna of CA HMO |
$20.22
|
| Rate for Payer: Cigna of CA PPO |
$23.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$26.86
|
| Rate for Payer: Global Benefits Group Commercial |
$18.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.12
|
| Rate for Payer: Multiplan Commercial |
$25.28
|
| Rate for Payer: Networks By Design Commercial |
$20.54
|
| Rate for Payer: Prime Health Services Commercial |
$26.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.80
|
| Rate for Payer: United Healthcare All Other HMO |
$15.80
|
| Rate for Payer: United Healthcare HMO Rider |
$15.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.86
|
| Rate for Payer: Vantage Medical Group Senior |
$26.86
|
|
