|
HC SOM REPTILASE TIME
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$101.66 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.66
|
| Rate for Payer: Blue Shield of California Commercial |
$18.44
|
| Rate for Payer: Blue Shield of California Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.25
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.98
|
| Rate for Payer: United Healthcare All Other HMO |
$7.98
|
| Rate for Payer: United Healthcare HMO Rider |
$7.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.84
|
| Rate for Payer: Vantage Medical Group Senior |
$9.85
|
|
|
HC SOM REPTILASE TIME
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
900910114
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM RESPIRATORY PANEL VARIES
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900915466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SOM RESPIRATORY PANEL VARIES
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900915466
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$3,405.38 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,385.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,405.38
|
| Rate for Payer: Blue Shield of California Commercial |
$129.08
|
| Rate for Payer: Blue Shield of California Commercial |
$195.16
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$622.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC SOM RIBOSOMAL P AB
|
Facility
|
OP
|
$44.68
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| 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 |
$20.60
|
| Rate for Payer: Blue Shield of California Commercial |
$31.14
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.06
|
| 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 |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$37.98
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| 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 |
$28.37
|
| 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 |
$10.72
|
| 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 |
$35.74
|
| Rate for Payer: Networks By Design Commercial |
$29.04
|
| Rate for Payer: Prime Health Services Commercial |
$37.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| 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
|
|
|
HC SOM RIBOSOMAL P AB
|
Facility
|
IP
|
$44.68
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$37.98 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$44.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$17.87
|
| Rate for Payer: Galaxy Health WC |
$37.98
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.72
|
| Rate for Payer: Multiplan Commercial |
$35.74
|
| Rate for Payer: Networks By Design Commercial |
$29.04
|
| Rate for Payer: Prime Health Services Commercial |
$37.98
|
|
|
HC SOM RISPERIDONE
|
Facility
|
OP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$154.20 |
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.20
|
| Rate for Payer: Blue Shield of California Commercial |
$39.63
|
| Rate for Payer: Blue Shield of California Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Cigna of CA HMO |
$55.01
|
| Rate for Payer: Cigna of CA PPO |
$63.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.38
|
| Rate for Payer: EPIC Health Plan Senior |
$34.38
|
| Rate for Payer: Galaxy Health WC |
$73.07
|
| Rate for Payer: Global Benefits Group Commercial |
$51.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.17
|
| Rate for Payer: Multiplan Commercial |
$68.77
|
| Rate for Payer: Networks By Design Commercial |
$55.87
|
| Rate for Payer: Prime Health Services Commercial |
$73.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.98
|
| Rate for Payer: United Healthcare All Other HMO |
$42.98
|
| Rate for Payer: United Healthcare HMO Rider |
$42.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.07
|
| Rate for Payer: Vantage Medical Group Senior |
$73.07
|
|
|
HC SOM RISPERIDONE
|
Facility
|
IP
|
$85.96
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900910787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$73.07 |
| Rate for Payer: Galaxy Health WC |
$73.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.38
|
| Rate for Payer: EPIC Health Plan Senior |
$34.38
|
| Rate for Payer: Adventist Health Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$85.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.17
|
| Rate for Payer: Global Benefits Group Commercial |
$51.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.63
|
| Rate for Payer: Multiplan Commercial |
$68.77
|
| Rate for Payer: Networks By Design Commercial |
$55.87
|
| Rate for Payer: Prime Health Services Commercial |
$73.07
|
|
|
HC SOM RISTOCETIN-WILLEBRAND FACTOR
|
Facility
|
OP
|
$40.30
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
900911282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$236.82 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.82
|
| Rate for Payer: Blue Shield of California Commercial |
$18.58
|
| Rate for Payer: Blue Shield of California Commercial |
$28.09
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cigna of CA HMO |
$25.79
|
| Rate for Payer: Cigna of CA PPO |
$29.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.85
|
| Rate for Payer: EPIC Health Plan Senior |
$25.23
|
| Rate for Payer: Galaxy Health WC |
$34.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$32.24
|
| Rate for Payer: Networks By Design Commercial |
$26.20
|
| Rate for Payer: Prime Health Services Commercial |
$34.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM RISTOCETIN-WILLEBRAND FACTOR
|
Facility
|
IP
|
$40.30
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
900911282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.06 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Adventist Health Commercial |
$8.06
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.12
|
| Rate for Payer: EPIC Health Plan Senior |
$16.12
|
| Rate for Payer: Galaxy Health WC |
$34.26
|
| Rate for Payer: Global Benefits Group Commercial |
$24.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$32.24
|
| Rate for Payer: Networks By Design Commercial |
$26.20
|
| Rate for Payer: Prime Health Services Commercial |
$34.26
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
IP
|
$169.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$143.91 |
| Rate for Payer: Adventist Health Commercial |
$33.86
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.72
|
| Rate for Payer: EPIC Health Plan Senior |
$67.72
|
| Rate for Payer: Galaxy Health WC |
$143.91
|
| Rate for Payer: Global Benefits Group Commercial |
$101.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.63
|
| Rate for Payer: Multiplan Commercial |
$135.44
|
| Rate for Payer: Networks By Design Commercial |
$110.05
|
| Rate for Payer: Prime Health Services Commercial |
$143.91
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Cigna of CA PPO |
$13.72
|
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Cigna of CA HMO |
$11.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.47
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$14.83
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$18.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$14.83
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
OP
|
$169.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$143.91 |
| Rate for Payer: Adventist Health Commercial |
$33.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$118.00
|
| Rate for Payer: Blue Shield of California Commercial |
$78.05
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Cash Price |
$169.30
|
| Rate for Payer: Cigna of CA HMO |
$108.35
|
| Rate for Payer: Cigna of CA PPO |
$125.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.47
|
| Rate for Payer: Galaxy Health WC |
$143.91
|
| Rate for Payer: Global Benefits Group Commercial |
$101.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$135.44
|
| Rate for Payer: Networks By Design Commercial |
$110.05
|
| Rate for Payer: Prime Health Services Commercial |
$143.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SAL 86606
|
Facility
|
OP
|
$21.57
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.38
|
| Rate for Payer: Blue Shield of California Commercial |
$15.03
|
| Rate for Payer: Blue Shield of California Commercial |
$9.94
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cigna of CA HMO |
$13.80
|
| Rate for Payer: Cigna of CA PPO |
$15.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$18.33
|
| Rate for Payer: Global Benefits Group Commercial |
$12.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$17.26
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Prime Health Services Commercial |
$18.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM SAL 86606
|
Facility
|
IP
|
$21.57
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$18.33 |
| Rate for Payer: Adventist Health Commercial |
$4.31
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.63
|
| Rate for Payer: EPIC Health Plan Senior |
$8.63
|
| Rate for Payer: Galaxy Health WC |
$18.33
|
| Rate for Payer: Global Benefits Group Commercial |
$12.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$17.26
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Prime Health Services Commercial |
$18.33
|
|
|
HC SOM SAL 86671A
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.23
|
| Rate for Payer: Blue Shield of California Commercial |
$8.09
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.47
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SAL 86671A
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.92 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$14.04
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
HC SOM SAL 86671B
|
Facility
|
IP
|
$17.56
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.93 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Senior |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.93
|
| Rate for Payer: Global Benefits Group Commercial |
$10.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$14.05
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.93
|
|
|
HC SOM SAL 86671B
|
Facility
|
OP
|
$17.56
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cash Price |
$17.56
|
| Rate for Payer: Cigna of CA HMO |
$11.24
|
| Rate for Payer: Cigna of CA PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.21
|
| Rate for Payer: EPIC Health Plan Senior |
$13.47
|
| Rate for Payer: Galaxy Health WC |
$14.93
|
| Rate for Payer: Global Benefits Group Commercial |
$10.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$14.05
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.47
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SARS-COV-2 IGG
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900915349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$305.75 |
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$292.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.75
|
| Rate for Payer: Blue Shield of California Commercial |
$19.82
|
| Rate for Payer: Blue Shield of California Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.51
|
| Rate for Payer: EPIC Health Plan Senior |
$46.34
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$69.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.13
|
| Rate for Payer: United Healthcare All Other HMO |
$34.13
|
| Rate for Payer: United Healthcare HMO Rider |
$34.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Vantage Medical Group Senior |
$42.13
|
|
|
HC SOM SARS-COV-2 IGG
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900915349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: Adventist Health Commercial |
$8.60
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: EPIC Health Plan Senior |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$34.40
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC SOM SCHISTOSOMIASIS AB IGG
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC SOM SCHISTOSOMIASIS AB IGG
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.50
|
| Rate for Payer: Blue Shield of California Commercial |
$26.28
|
| Rate for Payer: Blue Shield of California Commercial |
$39.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.47
|
| Rate for Payer: EPIC Health Plan Senior |
$14.31
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM SEBV EBNA
|
Facility
|
OP
|
$7.42
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900915457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$160.24 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$4.75
|
| Rate for Payer: Cigna of CA PPO |
$5.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.23
|
| Rate for Payer: EPIC Health Plan Senior |
$16.82
|
| Rate for Payer: Galaxy Health WC |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.49
|
| Rate for Payer: Multiplan Commercial |
$5.94
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.29
|
|
