|
HC SOM TRSF 84466
|
Facility
|
IP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$23.19 |
| Rate for Payer: Adventist Health Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$27.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$10.91
|
| Rate for Payer: Galaxy Health WC |
$23.19
|
| Rate for Payer: Global Benefits Group Commercial |
$16.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.55
|
| Rate for Payer: Multiplan Commercial |
$21.82
|
| Rate for Payer: Networks By Design Commercial |
$17.73
|
| Rate for Payer: Prime Health Services Commercial |
$23.19
|
|
|
HC SOM TRYPTASE
|
Facility
|
IP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.05 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.08
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$32.05
|
| Rate for Payer: Global Benefits Group Commercial |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.16
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$32.05
|
|
|
HC SOM TRYPTASE
|
Facility
|
OP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.73
|
| 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 |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$25.22
|
| Rate for Payer: Blue Shield of California EPN |
$16.66
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cigna of CA HMO |
$24.13
|
| Rate for Payer: Cigna of CA PPO |
$27.90
|
| 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: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$32.05
|
| Rate for Payer: Global Benefits Group Commercial |
$22.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 Permanente of CA Commercial/Self Funded |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| 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 |
$30.16
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$32.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.62
|
| 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 TSH SENSITIVE, SERUM
|
Facility
|
IP
|
$24.06
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900913813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.62
|
| Rate for Payer: EPIC Health Plan Senior |
$9.62
|
| Rate for Payer: Galaxy Health WC |
$20.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$19.25
|
| Rate for Payer: Networks By Design Commercial |
$15.64
|
| Rate for Payer: Prime Health Services Commercial |
$20.45
|
|
|
HC SOM TSH SENSITIVE, SERUM
|
Facility
|
OP
|
$24.06
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900913813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.98
|
| Rate for Payer: Blue Shield of California Commercial |
$16.10
|
| Rate for Payer: Blue Shield of California EPN |
$10.63
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cigna of CA HMO |
$15.40
|
| Rate for Payer: Cigna of CA PPO |
$17.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$20.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$19.25
|
| Rate for Payer: Networks By Design Commercial |
$15.64
|
| Rate for Payer: Prime Health Services Commercial |
$20.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC SOM TTFB 84402A
|
Facility
|
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$256.88 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.19
|
| 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 |
$54.26
|
| Rate for Payer: Blue Shield of California EPN |
$35.85
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cigna of CA HMO |
$51.90
|
| Rate for Payer: Cigna of CA PPO |
$60.01
|
| 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 |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| 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 Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.46
|
| 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 |
$64.88
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.66
|
| 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 TTFB 84402A
|
Facility
|
IP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$68.94 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.44
|
| Rate for Payer: EPIC Health Plan Senior |
$32.44
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.46
|
| Rate for Payer: Multiplan Commercial |
$64.88
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
|
|
HC SOM TTFB 84402B
|
Facility
|
IP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$68.94 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.44
|
| Rate for Payer: EPIC Health Plan Senior |
$32.44
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.46
|
| Rate for Payer: Multiplan Commercial |
$64.88
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
|
|
HC SOM TTFB 84402B
|
Facility
|
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$256.88 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.19
|
| 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 |
$54.26
|
| Rate for Payer: Blue Shield of California EPN |
$35.85
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cigna of CA HMO |
$51.90
|
| Rate for Payer: Cigna of CA PPO |
$60.01
|
| 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 |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| 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 Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.46
|
| 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 |
$64.88
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.66
|
| 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 TTFB 84403
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.89
|
| Rate for Payer: EPIC Health Plan Senior |
$32.89
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$65.78
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
|
|
HC SOM TTFB 84403
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$254.95 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.95
|
| Rate for Payer: Blue Shield of California Commercial |
$55.01
|
| Rate for Payer: Blue Shield of California EPN |
$36.35
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$60.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$65.78
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM UBEMS 81406
|
Facility
|
IP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$822.38 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.00
|
| Rate for Payer: EPIC Health Plan Senior |
$387.00
|
| Rate for Payer: Galaxy Health WC |
$822.38
|
| Rate for Payer: Global Benefits Group Commercial |
$580.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$645.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$598.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$628.88
|
| Rate for Payer: Prime Health Services Commercial |
$822.38
|
|
|
HC SOM UBEMS 81406
|
Facility
|
OP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$2,374.47 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$634.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,374.47
|
| Rate for Payer: Blue Shield of California Commercial |
$647.26
|
| Rate for Payer: Blue Shield of California EPN |
$427.63
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cigna of CA HMO |
$619.20
|
| Rate for Payer: Cigna of CA PPO |
$715.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.89
|
| Rate for Payer: EPIC Health Plan Senior |
$282.88
|
| Rate for Payer: Galaxy Health WC |
$822.38
|
| Rate for Payer: Global Benefits Group Commercial |
$580.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$475.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$645.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$628.88
|
| Rate for Payer: Prime Health Services Commercial |
$822.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$580.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$580.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$234.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.94
|
| Rate for Payer: Blue Shield of California Commercial |
$238.83
|
| Rate for Payer: Blue Shield of California EPN |
$157.79
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna of CA HMO |
$228.48
|
| Rate for Payer: Cigna of CA PPO |
$264.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
|
IP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.19
|
| Rate for Payer: EPIC Health Plan Senior |
$110.19
|
| Rate for Payer: Galaxy Health WC |
$234.16
|
| Rate for Payer: Global Benefits Group Commercial |
$165.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.12
|
| Rate for Payer: Multiplan Commercial |
$220.38
|
| Rate for Payer: Networks By Design Commercial |
$179.06
|
| Rate for Payer: Prime Health Services Commercial |
$234.16
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
|
OP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$734.66 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.66
|
| Rate for Payer: Blue Shield of California Commercial |
$184.30
|
| Rate for Payer: Blue Shield of California EPN |
$121.76
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna of CA HMO |
$176.31
|
| Rate for Payer: Cigna of CA PPO |
$203.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.95
|
| Rate for Payer: EPIC Health Plan Senior |
$150.33
|
| Rate for Payer: Galaxy Health WC |
$234.16
|
| Rate for Payer: Global Benefits Group Commercial |
$165.29
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$252.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.44
|
| Rate for Payer: Multiplan Commercial |
$220.38
|
| Rate for Payer: Networks By Design Commercial |
$179.06
|
| Rate for Payer: Prime Health Services Commercial |
$234.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.77
|
| Rate for Payer: United Healthcare All Other HMO |
$121.77
|
| Rate for Payer: United Healthcare HMO Rider |
$121.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: Vantage Medical Group Senior |
$150.33
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
|
OP
|
$37.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$7.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Blue Shield of California EPN |
$16.57
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna of CA HMO |
$24.00
|
| Rate for Payer: Cigna of CA PPO |
$27.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$31.88
|
| Rate for Payer: Global Benefits Group Commercial |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$24.38
|
| Rate for Payer: Prime Health Services Commercial |
$31.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
|
IP
|
$37.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$31.88 |
| Rate for Payer: Adventist Health Commercial |
$7.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15.00
|
| Rate for Payer: Galaxy Health WC |
$31.88
|
| Rate for Payer: Global Benefits Group Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$24.38
|
| Rate for Payer: Prime Health Services Commercial |
$31.88
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
|
OP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$9.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.26
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: EPIC Health Plan Senior |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$231.08 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.08
|
| Rate for Payer: Blue Shield of California Commercial |
$11.71
|
| Rate for Payer: Blue Shield of California EPN |
$7.74
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna of CA HMO |
$11.20
|
| Rate for Payer: Cigna of CA PPO |
$12.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$14.00
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.88 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.00
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.64
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Senior |
$35.33
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.34
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.62
|
| Rate for Payer: United Healthcare All Other HMO |
$28.62
|
| Rate for Payer: United Healthcare HMO Rider |
$28.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Vantage Medical Group Senior |
$35.33
|
|
