|
HC SOM PROTOPORPH FR RBC
|
Facility
|
IP
|
$126.77
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900911168
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Adventist Health Commercial |
$25.35
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.71
|
| Rate for Payer: EPIC Health Plan Senior |
$50.71
|
| Rate for Payer: Galaxy Health WC |
$107.75
|
| Rate for Payer: Global Benefits Group Commercial |
$76.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$101.42
|
| Rate for Payer: Networks By Design Commercial |
$82.40
|
| Rate for Payer: Prime Health Services Commercial |
$107.75
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
OP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$177.20 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.20
|
| Rate for Payer: Blue Shield of California Commercial |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$43.90
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.54
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.09
|
| Rate for Payer: Multiplan Commercial |
$50.39
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.50
|
| Rate for Payer: United Healthcare All Other HMO |
$31.50
|
| Rate for Payer: United Healthcare HMO Rider |
$31.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.54
|
| Rate for Payer: Vantage Medical Group Senior |
$53.54
|
|
|
HC SOM PROTRIPTYLINE (VIVACTYL)
|
Facility
|
IP
|
$62.99
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911246
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$53.54 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$62.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: EPIC Health Plan Senior |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.54
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.39
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.54
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
OP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$189.84 |
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.84
|
| Rate for Payer: Blue Shield of California Commercial |
$56.89
|
| Rate for Payer: Blue Shield of California Commercial |
$86.01
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Cigna of CA HMO |
$78.98
|
| Rate for Payer: Cigna of CA PPO |
$91.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$98.72
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PSA ULTRASENSITIVE
|
Facility
|
IP
|
$123.40
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900913953
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$104.89 |
| Rate for Payer: Galaxy Health WC |
$104.89
|
| Rate for Payer: Adventist Health Commercial |
$24.68
|
| Rate for Payer: Cash Price |
$123.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.36
|
| Rate for Payer: EPIC Health Plan Senior |
$49.36
|
| Rate for Payer: Global Benefits Group Commercial |
$74.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$72.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.62
|
| Rate for Payer: Multiplan Commercial |
$98.72
|
| Rate for Payer: Networks By Design Commercial |
$80.21
|
| Rate for Payer: Prime Health Services Commercial |
$104.89
|
|
|
HC SOM PST
|
Facility
|
OP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$158.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.43
|
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.23
|
| Rate for Payer: Blue Shield of California Commercial |
$47.64
|
| Rate for Payer: Blue Shield of California Commercial |
$72.03
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cigna of CA HMO |
$66.14
|
| Rate for Payer: Cigna of CA PPO |
$76.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.28
|
| Rate for Payer: EPIC Health Plan Senior |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$87.85
|
| Rate for Payer: Global Benefits Group Commercial |
$62.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$82.68
|
| Rate for Payer: Networks By Design Commercial |
$67.18
|
| Rate for Payer: Prime Health Services Commercial |
$87.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM PST
|
Facility
|
IP
|
$103.35
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
900914755
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$87.85 |
| Rate for Payer: Adventist Health Commercial |
$20.67
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.34
|
| Rate for Payer: EPIC Health Plan Senior |
$41.34
|
| Rate for Payer: Galaxy Health WC |
$87.85
|
| Rate for Payer: Global Benefits Group Commercial |
$62.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$82.68
|
| Rate for Payer: Networks By Design Commercial |
$67.18
|
| Rate for Payer: Prime Health Services Commercial |
$87.85
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.86
|
| Rate for Payer: Blue Shield of California Commercial |
$10.89
|
| Rate for Payer: Blue Shield of California Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cigna of CA HMO |
$10.00
|
| Rate for Payer: Cigna of CA PPO |
$11.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.53
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$12.50
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM PTH RELATED PROTEIN
|
Facility
|
IP
|
$15.62
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900911417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Adventist Health Commercial |
$3.12
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.25
|
| Rate for Payer: EPIC Health Plan Senior |
$6.25
|
| Rate for Payer: Galaxy Health WC |
$13.28
|
| Rate for Payer: Global Benefits Group Commercial |
$9.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$12.50
|
| Rate for Payer: Networks By Design Commercial |
$10.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.28
|
|
|
HC SOM PWDNA 81331
|
Facility
|
IP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$476.99 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.47
|
| Rate for Payer: EPIC Health Plan Senior |
$224.47
|
| Rate for Payer: Galaxy Health WC |
$476.99
|
| Rate for Payer: Global Benefits Group Commercial |
$336.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$331.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.68
|
| Rate for Payer: Multiplan Commercial |
$448.94
|
| Rate for Payer: Networks By Design Commercial |
$364.76
|
| Rate for Payer: Prime Health Services Commercial |
$476.99
|
|
|
HC SOM PWDNA 81331
|
Facility
|
OP
|
$561.17
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
900914888
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$476.99 |
| Rate for Payer: Adventist Health Commercial |
$112.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.89
|
| Rate for Payer: Blue Shield of California Commercial |
$258.70
|
| Rate for Payer: Blue Shield of California Commercial |
$391.14
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cash Price |
$561.17
|
| Rate for Payer: Cigna of CA HMO |
$359.15
|
| Rate for Payer: Cigna of CA PPO |
$415.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.27
|
| Rate for Payer: EPIC Health Plan Senior |
$56.18
|
| Rate for Payer: Galaxy Health WC |
$476.99
|
| Rate for Payer: Global Benefits Group Commercial |
$336.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.43
|
| Rate for Payer: Multiplan Commercial |
$448.94
|
| Rate for Payer: Networks By Design Commercial |
$364.76
|
| Rate for Payer: Prime Health Services Commercial |
$476.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.36
|
| Rate for Payer: United Healthcare All Other HMO |
$41.36
|
| Rate for Payer: United Healthcare HMO Rider |
$41.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.18
|
| Rate for Payer: Vantage Medical Group Senior |
$51.07
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
IP
|
$64.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$55.05 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Cash Price |
$64.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.90
|
| Rate for Payer: EPIC Health Plan Senior |
$25.90
|
| Rate for Payer: Galaxy Health WC |
$55.05
|
| Rate for Payer: Global Benefits Group Commercial |
$38.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.54
|
| Rate for Payer: Multiplan Commercial |
$51.81
|
| Rate for Payer: Networks By Design Commercial |
$42.09
|
| Rate for Payer: Prime Health Services Commercial |
$55.05
|
|
|
HC SOM PYRUVATE KINASE
|
Facility
|
OP
|
$64.76
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
900911491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$97.35 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.35
|
| Rate for Payer: Blue Shield of California Commercial |
$29.85
|
| Rate for Payer: Blue Shield of California Commercial |
$45.14
|
| Rate for Payer: Cash Price |
$64.76
|
| Rate for Payer: Cash Price |
$64.76
|
| Rate for Payer: Cigna of CA HMO |
$41.45
|
| Rate for Payer: Cigna of CA PPO |
$47.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$10.38
|
| Rate for Payer: Galaxy Health WC |
$55.05
|
| Rate for Payer: Global Benefits Group Commercial |
$38.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.65
|
| Rate for Payer: Multiplan Commercial |
$51.81
|
| Rate for Payer: Networks By Design Commercial |
$42.09
|
| Rate for Payer: Prime Health Services Commercial |
$55.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.65
|
| Rate for Payer: United Healthcare HMO Rider |
$7.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.38
|
| Rate for Payer: Vantage Medical Group Senior |
$9.44
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Senior |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
|
|
HC SOM Q FEVER IGG PHAS I
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$130.29 |
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO |
$10.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.33
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Senior |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
|
|
HC SOM Q FEVER IGG PHAS II
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914334
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$130.29 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO |
$10.41
|
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.33
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$130.29 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO |
$10.41
|
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.33
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM Q FEVER IGM PHAS I
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Senior |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$13.82 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.50
|
| Rate for Payer: EPIC Health Plan Senior |
$6.50
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
|
|
HC SOM Q FEVER IGM PHAS II
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900914335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$130.29 |
| Rate for Payer: Adventist Health Commercial |
$3.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.50
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cash Price |
$16.26
|
| Rate for Payer: Cigna of CA HMO |
$10.41
|
| Rate for Payer: Cigna of CA PPO |
$12.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.33
|
| Rate for Payer: Galaxy Health WC |
$13.82
|
| Rate for Payer: Global Benefits Group Commercial |
$9.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$13.01
|
| Rate for Payer: Networks By Design Commercial |
$10.57
|
| Rate for Payer: Prime Health Services Commercial |
$13.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$625.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$515.44
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.75
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.27
|
| Rate for Payer: EPIC Health Plan Senior |
$68.18
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$61.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.05
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.20
|
| Rate for Payer: United Healthcare All Other HMO |
$50.20
|
| Rate for Payer: United Healthcare HMO Rider |
$50.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$61.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.18
|
| Rate for Payer: Vantage Medical Group Senior |
$61.98
|
|
|
HC SOM RENIN ACT PLASMA
|
Facility
|
IP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.49
|
| Rate for Payer: EPIC Health Plan Senior |
$5.49
|
| Rate for Payer: Galaxy Health WC |
$11.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Multiplan Commercial |
$10.98
|
| Rate for Payer: Networks By Design Commercial |
$8.92
|
| Rate for Payer: Prime Health Services Commercial |
$11.66
|
|
|
HC SOM RENIN ACT PLASMA
|
Facility
|
OP
|
$13.72
|
|
|
Service Code
|
CPT 84244
|
| Hospital Charge Code |
900910955
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$227.02 |
| Rate for Payer: Adventist Health Commercial |
$2.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.02
|
| Rate for Payer: Blue Shield of California Commercial |
$6.32
|
| Rate for Payer: Blue Shield of California Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cash Price |
$13.72
|
| Rate for Payer: Cigna of CA HMO |
$8.78
|
| Rate for Payer: Cigna of CA PPO |
$10.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.28
|
| Rate for Payer: EPIC Health Plan Senior |
$24.19
|
| Rate for Payer: Galaxy Health WC |
$11.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.47
|
| Rate for Payer: Multiplan Commercial |
$10.98
|
| Rate for Payer: Networks By Design Commercial |
$8.92
|
| Rate for Payer: Prime Health Services Commercial |
$11.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.81
|
| Rate for Payer: United Healthcare All Other HMO |
$17.81
|
| Rate for Payer: United Healthcare HMO Rider |
$17.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.19
|
| Rate for Payer: Vantage Medical Group Senior |
$21.99
|
|
