|
HC SOM TTFB 84402B
|
Facility
|
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$268.44 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.44
|
| Rate for Payer: Blue Shield of California Commercial |
$37.39
|
| Rate for Payer: Blue Shield of California Commercial |
$56.53
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cigna of CA HMO |
$51.90
|
| Rate for Payer: Cigna of CA PPO |
$60.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.03
|
| Rate for Payer: EPIC Health Plan Senior |
$28.02
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$64.88
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.63
|
| Rate for Payer: United Healthcare All Other HMO |
$20.63
|
| Rate for Payer: United Healthcare HMO Rider |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TTFB 84402B
|
Facility
|
IP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$68.94 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.44
|
| Rate for Payer: EPIC Health Plan Senior |
$32.44
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.46
|
| Rate for Payer: Multiplan Commercial |
$64.88
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
|
|
HC SOM TTFB 84403
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$266.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$214.68
|
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.42
|
| 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 |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Senior |
$28.39
|
| 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 |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| 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 |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM TTFB 84403
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
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 UBEMS 81406
|
Facility
|
OP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$2,481.31 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,481.31
|
| Rate for Payer: Blue Shield of California Commercial |
$446.02
|
| Rate for Payer: Blue Shield of California Commercial |
$674.35
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cigna of CA HMO |
$619.20
|
| Rate for Payer: Cigna of CA PPO |
$715.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$677.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.75
|
| Rate for Payer: EPIC Health Plan Senior |
$311.17
|
| Rate for Payer: Galaxy Health WC |
$822.38
|
| Rate for Payer: Global Benefits Group Commercial |
$580.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$475.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$396.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$356.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$628.88
|
| Rate for Payer: Prime Health Services Commercial |
$822.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$580.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$580.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOM UBEMS 81406
|
Facility
|
IP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$822.38 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$677.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.00
|
| Rate for Payer: EPIC Health Plan Senior |
$387.00
|
| Rate for Payer: Galaxy Health WC |
$822.38
|
| Rate for Payer: Global Benefits Group Commercial |
$580.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$570.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$628.88
|
| Rate for Payer: Prime Health Services Commercial |
$822.38
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.87
|
| Rate for Payer: Blue Shield of California Commercial |
$164.58
|
| Rate for Payer: Blue Shield of California Commercial |
$248.83
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna of CA HMO |
$228.48
|
| Rate for Payer: Cigna of CA PPO |
$264.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.31
|
| Rate for Payer: EPIC Health Plan Senior |
$20.21
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
|
OP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$767.71 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$417.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.71
|
| Rate for Payer: Blue Shield of California Commercial |
$127.00
|
| Rate for Payer: Blue Shield of California Commercial |
$192.01
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna of CA HMO |
$176.31
|
| Rate for Payer: Cigna of CA PPO |
$203.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.04
|
| Rate for Payer: EPIC Health Plan Senior |
$165.36
|
| Rate for Payer: Galaxy Health WC |
$234.16
|
| Rate for Payer: Global Benefits Group Commercial |
$165.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$252.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.44
|
| Rate for Payer: Multiplan Commercial |
$220.38
|
| Rate for Payer: Networks By Design Commercial |
$179.06
|
| Rate for Payer: Prime Health Services Commercial |
$234.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.77
|
| Rate for Payer: United Healthcare All Other HMO |
$121.77
|
| Rate for Payer: United Healthcare HMO Rider |
$121.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: Vantage Medical Group Senior |
$150.33
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
|
IP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.19
|
| Rate for Payer: EPIC Health Plan Senior |
$110.19
|
| Rate for Payer: Galaxy Health WC |
$234.16
|
| Rate for Payer: Global Benefits Group Commercial |
$165.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.12
|
| Rate for Payer: Multiplan Commercial |
$220.38
|
| Rate for Payer: Networks By Design Commercial |
$179.06
|
| Rate for Payer: Prime Health Services Commercial |
$234.16
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
|
OP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.04 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: EPIC Health Plan Senior |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$11.34
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$14.88 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$14.00
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| 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 |
$12.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna of CA HMO |
$11.20
|
| Rate for Payer: Cigna of CA PPO |
$12.95
|
| 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 |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| 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 |
$11.11
|
| 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 |
$4.20
|
| 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 |
$14.00
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
|
IP
|
$53.71
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$45.65 |
| Rate for Payer: Adventist Health Commercial |
$10.74
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.48
|
| Rate for Payer: EPIC Health Plan Senior |
$21.48
|
| Rate for Payer: Galaxy Health WC |
$45.65
|
| Rate for Payer: Global Benefits Group Commercial |
$32.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$42.97
|
| Rate for Payer: Networks By Design Commercial |
$34.91
|
| Rate for Payer: Prime Health Services Commercial |
$45.65
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
|
OP
|
$53.71
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$293.80 |
| Rate for Payer: Cigna of CA PPO |
$39.75
|
| Rate for Payer: Adventist Health Commercial |
$10.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$293.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.84
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California Commercial |
$37.44
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Cigna of CA HMO |
$34.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.29
|
| Rate for Payer: EPIC Health Plan Senior |
$38.86
|
| Rate for Payer: Galaxy Health WC |
$45.65
|
| Rate for Payer: Global Benefits Group Commercial |
$32.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.34
|
| Rate for Payer: Multiplan Commercial |
$42.97
|
| Rate for Payer: Networks By Design Commercial |
$34.91
|
| Rate for Payer: Prime Health Services Commercial |
$45.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.62
|
| Rate for Payer: United Healthcare All Other HMO |
$28.62
|
| Rate for Payer: United Healthcare HMO Rider |
$28.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Vantage Medical Group Senior |
$35.33
|
|
|
HC SOM VDER 87529
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM VDER 87529
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$23.17
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM VDER 87798
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$23.17
|
| Rate for Payer: Blue Shield of California Commercial |
$35.04
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM VDER 87798
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM VEDOLIZUMAB AB
|
Facility
|
OP
|
$62.98
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$145.86 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.86
|
| Rate for Payer: Blue Shield of California Commercial |
$29.03
|
| Rate for Payer: Blue Shield of California Commercial |
$43.90
|
| Rate for Payer: Cash Price |
$62.98
|
| Rate for Payer: Cash Price |
$62.98
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.53
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM VEDOLIZUMAB AB
|
Facility
|
IP
|
$62.98
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Adventist Health Commercial |
$12.60
|
| Rate for Payer: Cash Price |
$62.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: EPIC Health Plan Senior |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.38
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
|
|
HC SOM VEDOLIZUMAB QN
|
Facility
|
OP
|
$172.02
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
900915324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$227.89 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$119.90
|
| Rate for Payer: Blue Shield of California Commercial |
$79.30
|
| Rate for Payer: Cash Price |
$172.02
|
| Rate for Payer: Cash Price |
$172.02
|
| Rate for Payer: Cigna of CA HMO |
$110.09
|
| Rate for Payer: Cigna of CA PPO |
$127.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$146.22
|
| Rate for Payer: Global Benefits Group Commercial |
$103.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$137.62
|
| Rate for Payer: Networks By Design Commercial |
$111.81
|
| Rate for Payer: Prime Health Services Commercial |
$146.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
|
