|
HC SOM PARANEOPL EVAL P/Q AB
|
Facility
|
OP
|
$30.37
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900914658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$108.73 |
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.44
|
| Rate for Payer: Blue Shield of California Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.17
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Cigna of CA HMO |
$19.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$24.30
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PARANEOPL EVAL P/Q AB
|
Facility
|
IP
|
$30.37
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900914658
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$30.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.15
|
| Rate for Payer: EPIC Health Plan Senior |
$12.15
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$24.30
|
| Rate for Payer: Networks By Design Commercial |
$19.74
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PARANEOPL EVAL STR AB
|
Facility
|
OP
|
$30.33
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$13.98
|
| Rate for Payer: Blue Shield of California Commercial |
$21.14
|
| Rate for Payer: Cash Price |
$30.33
|
| Rate for Payer: Cash Price |
$30.33
|
| Rate for Payer: Cigna of CA HMO |
$19.41
|
| Rate for Payer: Cigna of CA PPO |
$22.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$25.78
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| 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 |
$24.26
|
| Rate for Payer: Networks By Design Commercial |
$19.71
|
| Rate for Payer: Prime Health Services Commercial |
$25.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM PARANEOPL EVAL STR AB
|
Facility
|
IP
|
$30.33
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915359
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.78 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$30.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.13
|
| Rate for Payer: EPIC Health Plan Senior |
$12.13
|
| Rate for Payer: Galaxy Health WC |
$25.78
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.26
|
| Rate for Payer: Networks By Design Commercial |
$19.71
|
| Rate for Payer: Prime Health Services Commercial |
$25.78
|
|
|
HC SOM PARASITIC EXAM CONC
|
Facility
|
OP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$68.93 |
| Rate for Payer: Cigna of CA PPO |
$21.25
|
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.93
|
| Rate for Payer: Blue Shield of California Commercial |
$13.24
|
| Rate for Payer: Blue Shield of California Commercial |
$20.01
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cigna of CA HMO |
$18.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.35
|
| Rate for Payer: Galaxy Health WC |
$24.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$22.97
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC SOM PARASITIC EXAM CONC
|
Facility
|
IP
|
$28.71
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900914691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: Adventist Health Commercial |
$5.74
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.48
|
| Rate for Payer: Galaxy Health WC |
$24.40
|
| Rate for Payer: Global Benefits Group Commercial |
$17.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$22.97
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$24.40
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
|
OP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.44
|
| Rate for Payer: Blue Shield of California Commercial |
$35.62
|
| Rate for Payer: Blue Shield of California Commercial |
$53.86
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cigna of CA HMO |
$49.45
|
| Rate for Payer: Cigna of CA PPO |
$57.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.67
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$65.68
|
| Rate for Payer: Global Benefits Group Commercial |
$46.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$61.82
|
| Rate for Payer: Networks By Design Commercial |
$50.23
|
| Rate for Payer: Prime Health Services Commercial |
$65.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.56
|
| Rate for Payer: United Healthcare All Other HMO |
$14.56
|
| Rate for Payer: United Healthcare HMO Rider |
$14.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.78
|
| Rate for Payer: Vantage Medical Group Senior |
$17.98
|
|
|
HC SOM PARASITIC EXAM STAIN
|
Facility
|
IP
|
$77.27
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
900914692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$65.68 |
| Rate for Payer: Adventist Health Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$54.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.91
|
| Rate for Payer: EPIC Health Plan Senior |
$30.91
|
| Rate for Payer: Galaxy Health WC |
$65.68
|
| Rate for Payer: Global Benefits Group Commercial |
$46.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$49.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.54
|
| Rate for Payer: Multiplan Commercial |
$61.82
|
| Rate for Payer: Networks By Design Commercial |
$50.23
|
| Rate for Payer: Prime Health Services Commercial |
$65.68
|
|
|
HC SOM PARIETAL CELL AB
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$21.58 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Cash Price |
$25.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.16
|
| Rate for Payer: EPIC Health Plan Senior |
$10.16
|
| Rate for Payer: Galaxy Health WC |
$21.58
|
| Rate for Payer: Global Benefits Group Commercial |
$15.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.09
|
| Rate for Payer: Multiplan Commercial |
$20.31
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.58
|
|
|
HC SOM PARIETAL CELL AB
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Adventist Health Commercial |
$5.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| 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 |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$11.70
|
| Rate for Payer: Blue Shield of California Commercial |
$17.70
|
| Rate for Payer: Cash Price |
$25.39
|
| Rate for Payer: Cash Price |
$25.39
|
| Rate for Payer: Cigna of CA HMO |
$16.25
|
| Rate for Payer: Cigna of CA PPO |
$18.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$21.58
|
| Rate for Payer: Global Benefits Group Commercial |
$15.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$16.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.09
|
| 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 |
$20.31
|
| Rate for Payer: Networks By Design Commercial |
$16.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.23
|
| 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 PARVOVIRUS B19 AB IGG
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM PARVOVIRUS B19 AB IGG
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912538
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.53
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.38
|
| Rate for Payer: Blue Shield of California Commercial |
$5.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.83
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.53
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.14
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.53
|
| Rate for Payer: Vantage Medical Group Senior |
$15.03
|
|
|
HC SOM PARVOVIRUS B19 AB IGM
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
900912694
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM PARVOVIRUS B19 PCR BF
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19.12
|
| Rate for Payer: Blue Shield of California Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$26.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| 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 |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| 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 PARVOVIRUS B19 PCR BF
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$35.26 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.59
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$35.26 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.59
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| Rate for Payer: Multiplan Commercial |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
|
|
HC SOM PARVOVIRUS PCR
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911590
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19.12
|
| Rate for Payer: Blue Shield of California Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cash Price |
$41.48
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$35.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$26.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.96
|
| 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 |
$33.18
|
| Rate for Payer: Networks By Design Commercial |
$26.96
|
| Rate for Payer: Prime Health Services Commercial |
$35.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| 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 PASSION FRUIT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM PASSION FRUIT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$3.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5.21
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PCA3 U
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.85
|
| Rate for Payer: Blue Shield of California Commercial |
$230.50
|
| Rate for Payer: Blue Shield of California Commercial |
$348.50
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna of CA HMO |
$320.00
|
| Rate for Payer: Cigna of CA PPO |
$370.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$425.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$425.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$350.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$350.00
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOM PCA3 U
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900913905
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Adventist Health Commercial |
$100.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Senior |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$317.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$295.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$400.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
|
|
HC SOM PCDEC AMPA-R AB CBA
|
Facility
|
IP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.02
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Multiplan Commercial |
$36.05
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
|
|
HC SOM PCDEC AMPA-R AB CBA
|
Facility
|
OP
|
$45.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Cigna of CA PPO |
$33.34
|
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$20.77
|
| Rate for Payer: Blue Shield of California Commercial |
$31.41
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Cash Price |
$45.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.30
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$36.05
|
| Rate for Payer: Networks By Design Commercial |
$29.29
|
| Rate for Payer: Prime Health Services Commercial |
$38.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDES AMPA-R AB CBA
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
