|
HC SOM SEBV EBNA
|
Facility
|
IP
|
$7.42
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
900915457
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.97
|
| Rate for Payer: EPIC Health Plan Senior |
$2.97
|
| Rate for Payer: Galaxy Health WC |
$6.31
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.78
|
| 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
|
|
|
HC SOM SEBV IGG
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.52
|
| Rate for Payer: EPIC Health Plan Senior |
$3.52
|
| Rate for Payer: Galaxy Health WC |
$7.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$7.03
|
| Rate for Payer: Networks By Design Commercial |
$5.71
|
| Rate for Payer: Prime Health Services Commercial |
$7.47
|
|
|
HC SOM SEBV IGG
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cigna of CA HMO |
$5.63
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$19.95
|
| Rate for Payer: Galaxy Health WC |
$7.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$7.03
|
| Rate for Payer: Networks By Design Commercial |
$5.71
|
| Rate for Payer: Prime Health Services Commercial |
$7.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC SOM SEBV IGM
|
Facility
|
OP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6.13
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Cigna of CA HMO |
$5.63
|
| Rate for Payer: Cigna of CA PPO |
$6.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$19.95
|
| Rate for Payer: Galaxy Health WC |
$7.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$7.03
|
| Rate for Payer: Networks By Design Commercial |
$5.71
|
| Rate for Payer: Prime Health Services Commercial |
$7.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC SOM SEBV IGM
|
Facility
|
IP
|
$8.79
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$7.47 |
| Rate for Payer: Adventist Health Commercial |
$1.76
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.52
|
| Rate for Payer: EPIC Health Plan Senior |
$3.52
|
| Rate for Payer: Galaxy Health WC |
$7.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.11
|
| Rate for Payer: Multiplan Commercial |
$7.03
|
| Rate for Payer: Networks By Design Commercial |
$5.71
|
| Rate for Payer: Prime Health Services Commercial |
$7.47
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
IP
|
$134.40
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Adventist Health Commercial |
$26.88
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.76
|
| Rate for Payer: EPIC Health Plan Senior |
$53.76
|
| Rate for Payer: Galaxy Health WC |
$114.24
|
| Rate for Payer: Global Benefits Group Commercial |
$80.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.26
|
| Rate for Payer: Multiplan Commercial |
$107.52
|
| Rate for Payer: Networks By Design Commercial |
$87.36
|
| Rate for Payer: Prime Health Services Commercial |
$114.24
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
OP
|
$134.40
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$26.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$61.96
|
| Rate for Payer: Blue Shield of California Commercial |
$93.68
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$86.02
|
| Rate for Payer: Cigna of CA PPO |
$99.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$114.24
|
| Rate for Payer: Global Benefits Group Commercial |
$80.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$107.52
|
| Rate for Payer: Networks By Design Commercial |
$87.36
|
| Rate for Payer: Prime Health Services Commercial |
$114.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$263.57 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.57
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.12
|
| Rate for Payer: EPIC Health Plan Senior |
$28.08
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.68
|
| Rate for Payer: United Healthcare All Other HMO |
$20.68
|
| Rate for Payer: United Healthcare HMO Rider |
$20.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$25.53
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM SEROTONIN BLOOD
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$319.72 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.72
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$24.39
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.12
|
| Rate for Payer: EPIC Health Plan Senior |
$34.08
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM SEROTONIN BLOOD
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900915358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900915358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$161.35
|
| Rate for Payer: Blue Shield of California Commercial |
$243.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$224.17 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.99
|
| Rate for Payer: Blue Shield of California Commercial |
$9.06
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.85
|
| Rate for Payer: EPIC Health Plan Senior |
$23.90
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.60
|
| Rate for Payer: United Healthcare All Other HMO |
$17.60
|
| Rate for Payer: United Healthcare HMO Rider |
$17.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$879.04 |
| Rate for Payer: EPIC Health Plan Senior |
$150.70
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.05
|
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$809.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$879.04
|
| Rate for Payer: Blue Shield of California Commercial |
$125.46
|
| Rate for Payer: Blue Shield of California Commercial |
$82.98
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$115.20
|
| Rate for Payer: Cigna of CA PPO |
$133.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
IP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.77
|
| Rate for Payer: EPIC Health Plan Senior |
$6.77
|
| Rate for Payer: Galaxy Health WC |
$14.39
|
| Rate for Payer: Global Benefits Group Commercial |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$13.54
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.39
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
OP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$68.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$68.13
|
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.42
|
| Rate for Payer: Blue Shield of California Commercial |
$11.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$12.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$14.39
|
| Rate for Payer: Global Benefits Group Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$13.54
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.16
|
| 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 |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$182.62 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.62
|
| Rate for Payer: Blue Shield of California Commercial |
$142.88
|
| Rate for Payer: Blue Shield of California Commercial |
$94.50
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.16
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Vantage Medical Group Senior |
$18.28
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC SOM SOTALOL
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.89
|
| Rate for Payer: EPIC Health Plan Senior |
$32.89
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$65.78
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
|
|
HC SOM SOTALOL
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$37.91
|
| Rate for Payer: Blue Shield of California Commercial |
$57.31
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$60.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$65.78
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$53.23 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.23
|
| Rate for Payer: Blue Shield of California Commercial |
$16.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
