|
HC SOM WHEY IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM WHEY IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
IP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.93 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.86
|
| Rate for Payer: EPIC Health Plan Senior |
$89.86
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.92
|
| Rate for Payer: Multiplan Commercial |
$179.72
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
|
|
HC SOM Y ENTEROCOL AB A G M
|
Facility
|
OP
|
$224.65
|
|
|
Service Code
|
CPT 86793
|
| Hospital Charge Code |
900914716
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Adventist Health Commercial |
$44.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$150.29
|
| Rate for Payer: Blue Shield of California EPN |
$99.30
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Cash Price |
$224.65
|
| Rate for Payer: Cigna of CA HMO |
$143.78
|
| Rate for Payer: Cigna of CA PPO |
$166.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$190.95
|
| Rate for Payer: Global Benefits Group Commercial |
$134.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$179.72
|
| Rate for Payer: Networks By Design Commercial |
$146.02
|
| Rate for Payer: Prime Health Services Commercial |
$190.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM ZINC
|
Facility
|
IP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$10.34 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.87
|
| Rate for Payer: EPIC Health Plan Senior |
$4.87
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Multiplan Commercial |
$9.74
|
| Rate for Payer: Networks By Design Commercial |
$7.91
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
|
|
HC SOM ZINC
|
Facility
|
OP
|
$12.17
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911152
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$112.51 |
| Rate for Payer: Adventist Health Commercial |
$2.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8.14
|
| Rate for Payer: Blue Shield of California EPN |
$5.38
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cigna of CA HMO |
$7.79
|
| Rate for Payer: Cigna of CA PPO |
$9.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$11.39
|
| Rate for Payer: Galaxy Health WC |
$10.34
|
| Rate for Payer: Global Benefits Group Commercial |
$7.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$9.74
|
| Rate for Payer: Networks By Design Commercial |
$7.91
|
| Rate for Payer: Prime Health Services Commercial |
$10.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$151.88 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.88
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Blue Shield of California EPN |
$66.30
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM ZINC URINE
|
Facility
|
OP
|
$185.52
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$157.69 |
| Rate for Payer: Adventist Health Commercial |
$37.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.51
|
| Rate for Payer: Blue Shield of California Commercial |
$124.11
|
| Rate for Payer: Blue Shield of California EPN |
$82.00
|
| Rate for Payer: Cash Price |
$185.52
|
| Rate for Payer: Cash Price |
$185.52
|
| Rate for Payer: Cigna of CA HMO |
$118.73
|
| Rate for Payer: Cigna of CA PPO |
$137.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$11.39
|
| Rate for Payer: Galaxy Health WC |
$157.69
|
| Rate for Payer: Global Benefits Group Commercial |
$111.31
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$148.42
|
| Rate for Payer: Networks By Design Commercial |
$120.59
|
| Rate for Payer: Prime Health Services Commercial |
$157.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC SOM ZINC URINE
|
Facility
|
IP
|
$185.52
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$157.69 |
| Rate for Payer: Adventist Health Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$185.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.21
|
| Rate for Payer: EPIC Health Plan Senior |
$74.21
|
| Rate for Payer: Galaxy Health WC |
$157.69
|
| Rate for Payer: Global Benefits Group Commercial |
$111.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.52
|
| Rate for Payer: Multiplan Commercial |
$148.42
|
| Rate for Payer: Networks By Design Commercial |
$120.59
|
| Rate for Payer: Prime Health Services Commercial |
$157.69
|
|
|
HC SOM ZONISAMIDE LEVEL
|
Facility
|
IP
|
$39.85
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$33.87 |
| Rate for Payer: Adventist Health Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.94
|
| Rate for Payer: EPIC Health Plan Senior |
$15.94
|
| Rate for Payer: Galaxy Health WC |
$33.87
|
| Rate for Payer: Global Benefits Group Commercial |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.56
|
| Rate for Payer: Multiplan Commercial |
$31.88
|
| Rate for Payer: Networks By Design Commercial |
$25.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.87
|
|
|
HC SOM ZONISAMIDE LEVEL
|
Facility
|
OP
|
$39.85
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Adventist Health Commercial |
$7.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.14
|
| 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 |
$78.73
|
| Rate for Payer: Blue Shield of California Commercial |
$26.66
|
| Rate for Payer: Blue Shield of California EPN |
$17.61
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Cigna of CA HMO |
$25.50
|
| Rate for Payer: Cigna of CA PPO |
$29.49
|
| 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 |
$33.87
|
| Rate for Payer: Global Benefits Group Commercial |
$23.91
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.56
|
| 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 |
$31.88
|
| Rate for Payer: Networks By Design Commercial |
$25.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.91
|
| 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 SONGI 14011200 HCV PCR QL
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.14
|
| 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 |
$157.22
|
| Rate for Payer: Blue Shield of California EPN |
$103.87
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| 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 |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| 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 |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| 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 SONGI 14011200 HCV PCR QL
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC SOP CELIAC PLUS
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.00
|
| Rate for Payer: EPIC Health Plan Senior |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
|
|
HC SOP CELIAC PLUS
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.54
|
| Rate for Payer: Blue Shield of California Commercial |
$85.30
|
| Rate for Payer: Blue Shield of California EPN |
$56.35
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna of CA HMO |
$81.60
|
| Rate for Payer: Cigna of CA PPO |
$94.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.50
|
| 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 |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
IP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$234.81 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Senior |
$110.50
|
| Rate for Payer: Galaxy Health WC |
$234.81
|
| Rate for Payer: Global Benefits Group Commercial |
$165.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Networks By Design Commercial |
$179.56
|
| Rate for Payer: Prime Health Services Commercial |
$234.81
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
OP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$831.88 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$181.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.88
|
| Rate for Payer: Blue Shield of California Commercial |
$184.81
|
| Rate for Payer: Blue Shield of California EPN |
$122.10
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cigna of CA HMO |
$176.80
|
| Rate for Payer: Cigna of CA PPO |
$204.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$234.81
|
| Rate for Payer: Global Benefits Group Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Networks By Design Commercial |
$179.56
|
| Rate for Payer: Prime Health Services Commercial |
$234.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
OP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.54
|
| Rate for Payer: Blue Shield of California Commercial |
$14.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.40
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cigna of CA HMO |
$13.61
|
| Rate for Payer: Cigna of CA PPO |
$15.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Senior |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$18.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$17.01
|
| Rate for Payer: Networks By Design Commercial |
$13.82
|
| Rate for Payer: Prime Health Services Commercial |
$18.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
IP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$17.01
|
| Rate for Payer: Networks By Design Commercial |
$13.82
|
| Rate for Payer: Prime Health Services Commercial |
$18.07
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
|
IP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.03
|
| Rate for Payer: EPIC Health Plan Senior |
$13.03
|
| Rate for Payer: Galaxy Health WC |
$27.69
|
| Rate for Payer: Global Benefits Group Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$26.06
|
| Rate for Payer: Networks By Design Commercial |
$21.18
|
| Rate for Payer: Prime Health Services Commercial |
$27.69
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
|
OP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.37
|
| 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 |
$21.80
|
| Rate for Payer: Blue Shield of California EPN |
$14.40
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cigna of CA HMO |
$20.85
|
| Rate for Payer: Cigna of CA PPO |
$24.11
|
| 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 |
$27.69
|
| Rate for Payer: Global Benefits Group Commercial |
$19.55
|
| 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 |
$21.73
|
| 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 |
$7.82
|
| 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 |
$26.06
|
| Rate for Payer: Networks By Design Commercial |
$21.18
|
| Rate for Payer: Prime Health Services Commercial |
$27.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.55
|
| 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 SOP CELIAC SEROLOGY
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.54
|
| Rate for Payer: Blue Shield of California Commercial |
$85.30
|
| Rate for Payer: Blue Shield of California EPN |
$56.35
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna of CA HMO |
$81.60
|
| Rate for Payer: Cigna of CA PPO |
$94.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.50
|
| 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 |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SOP CELIAC SEROLOGY
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.00
|
| Rate for Payer: EPIC Health Plan Senior |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
|
|
HC SOP TPMT ENZYME
|
Facility
|
IP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$79.47 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.40
|
| Rate for Payer: EPIC Health Plan Senior |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$79.47
|
| Rate for Payer: Global Benefits Group Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: Multiplan Commercial |
$74.80
|
| Rate for Payer: Networks By Design Commercial |
$60.77
|
| Rate for Payer: Prime Health Services Commercial |
$79.47
|
|
