|
HC SOM ZINC TRANSPORTER 8 AUTOAB
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$158.71 |
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.71
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM ZINC URINE
|
Facility
|
OP
|
$35.72
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$117.58 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.58
|
| Rate for Payer: Blue Shield of California Commercial |
$16.47
|
| Rate for Payer: Blue Shield of California Commercial |
$24.90
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cigna of CA HMO |
$22.86
|
| Rate for Payer: Cigna of CA PPO |
$26.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.79
|
| Rate for Payer: EPIC Health Plan Senior |
$12.53
|
| Rate for Payer: Galaxy Health WC |
$30.36
|
| Rate for Payer: Global Benefits Group Commercial |
$21.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$28.58
|
| Rate for Payer: Networks By Design Commercial |
$23.22
|
| Rate for Payer: Prime Health Services Commercial |
$30.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
HC SOM ZINC URINE
|
Facility
|
IP
|
$35.72
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.29
|
| Rate for Payer: Galaxy Health WC |
$30.36
|
| Rate for Payer: Global Benefits Group Commercial |
$21.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$28.58
|
| Rate for Payer: Networks By Design Commercial |
$23.22
|
| Rate for Payer: Prime Health Services Commercial |
$30.36
|
|
|
HC SOM ZONISAMIDE LEVEL
|
Facility
|
OP
|
$49.82
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$106.92 |
| Rate for Payer: Adventist Health Commercial |
$9.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.27
|
| Rate for Payer: Blue Shield of California Commercial |
$22.97
|
| Rate for Payer: Blue Shield of California Commercial |
$34.72
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Cigna of CA HMO |
$31.88
|
| Rate for Payer: Cigna of CA PPO |
$36.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.57
|
| Rate for Payer: Galaxy Health WC |
$42.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$39.86
|
| Rate for Payer: Networks By Design Commercial |
$32.38
|
| Rate for Payer: Prime Health Services Commercial |
$42.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM ZONISAMIDE LEVEL
|
Facility
|
IP
|
$49.82
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Adventist Health Commercial |
$9.96
|
| Rate for Payer: Cash Price |
$49.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.93
|
| Rate for Payer: EPIC Health Plan Senior |
$19.93
|
| Rate for Payer: Galaxy Health WC |
$42.35
|
| Rate for Payer: Global Benefits Group Commercial |
$29.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.96
|
| Rate for Payer: Multiplan Commercial |
$39.86
|
| Rate for Payer: Networks By Design Commercial |
$32.38
|
| Rate for Payer: Prime Health Services Commercial |
$42.35
|
|
|
HC SON ASPARAGINASE ASSAY
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.00
|
| Rate for Payer: EPIC Health Plan Senior |
$110.00
|
| Rate for Payer: Galaxy Health WC |
$233.75
|
| Rate for Payer: Global Benefits Group Commercial |
$165.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: Networks By Design Commercial |
$178.75
|
| Rate for Payer: Prime Health Services Commercial |
$233.75
|
|
|
HC SON ASPARAGINASE ASSAY
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$126.78
|
| Rate for Payer: Blue Shield of California Commercial |
$191.68
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cigna of CA HMO |
$176.00
|
| Rate for Payer: Cigna of CA PPO |
$203.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$233.75
|
| Rate for Payer: Global Benefits Group Commercial |
$165.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: Networks By Design Commercial |
$178.75
|
| Rate for Payer: Prime Health Services Commercial |
$233.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SONGI 14011200 HCV PCR QL
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$199.75 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC SONGI 14011200 HCV PCR QL
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| 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 |
$108.33
|
| Rate for Payer: Blue Shield of California Commercial |
$163.79
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cash Price |
$105.75
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| 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 |
$164.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| 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 |
$188.00
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| 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 SOP CELIAC PLUS
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$437.43 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.90
|
| Rate for Payer: Blue Shield of California Commercial |
$58.78
|
| Rate for Payer: Blue Shield of California Commercial |
$88.87
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna of CA HMO |
$81.60
|
| Rate for Payer: Cigna of CA PPO |
$94.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOP CELIAC PLUS
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.00
|
| Rate for Payer: EPIC Health Plan Senior |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
OP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$869.31 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$400.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$869.31
|
| Rate for Payer: Blue Shield of California Commercial |
$127.35
|
| Rate for Payer: Blue Shield of California Commercial |
$192.55
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Cigna of CA HMO |
$176.80
|
| Rate for Payer: Cigna of CA PPO |
$204.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.07
|
| Rate for Payer: EPIC Health Plan Senior |
$136.05
|
| Rate for Payer: Galaxy Health WC |
$234.81
|
| Rate for Payer: Global Benefits Group Commercial |
$165.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$173.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Networks By Design Commercial |
$179.56
|
| Rate for Payer: Prime Health Services Commercial |
$234.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
IP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$234.81 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Cash Price |
$124.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$193.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Senior |
$110.50
|
| Rate for Payer: Galaxy Health WC |
$234.81
|
| Rate for Payer: Global Benefits Group Commercial |
$165.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$221.00
|
| Rate for Payer: Networks By Design Commercial |
$179.56
|
| Rate for Payer: Prime Health Services Commercial |
$234.81
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
OP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$79.98 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.98
|
| Rate for Payer: Blue Shield of California Commercial |
$14.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Cigna of CA HMO |
$13.61
|
| Rate for Payer: Cigna of CA PPO |
$15.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$18.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$17.01
|
| Rate for Payer: Networks By Design Commercial |
$13.82
|
| Rate for Payer: Prime Health Services Commercial |
$18.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
IP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$18.07 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$9.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$17.01
|
| Rate for Payer: Networks By Design Commercial |
$13.82
|
| Rate for Payer: Prime Health Services Commercial |
$18.07
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
|
IP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$27.69 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.03
|
| Rate for Payer: EPIC Health Plan Senior |
$13.03
|
| Rate for Payer: Galaxy Health WC |
$27.69
|
| Rate for Payer: Global Benefits Group Commercial |
$19.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$26.06
|
| Rate for Payer: Networks By Design Commercial |
$21.18
|
| Rate for Payer: Prime Health Services Commercial |
$27.69
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
|
OP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$15.02
|
| Rate for Payer: Blue Shield of California Commercial |
$22.71
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cash Price |
$14.66
|
| Rate for Payer: Cigna of CA HMO |
$20.85
|
| Rate for Payer: Cigna of CA PPO |
$24.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$27.69
|
| Rate for Payer: Global Benefits Group Commercial |
$19.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$26.06
|
| Rate for Payer: Networks By Design Commercial |
$21.18
|
| Rate for Payer: Prime Health Services Commercial |
$27.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOP CELIAC SEROLOGY
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$437.43 |
| Rate for Payer: Cigna of CA PPO |
$94.35
|
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$437.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.90
|
| Rate for Payer: Blue Shield of California Commercial |
$58.78
|
| Rate for Payer: Blue Shield of California Commercial |
$88.87
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Cigna of CA HMO |
$81.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOP CELIAC SEROLOGY
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$108.38 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$57.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.00
|
| Rate for Payer: EPIC Health Plan Senior |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
|
|
HC SOP TPMT ENZYME
|
Facility
|
OP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| 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 |
$43.10
|
| Rate for Payer: Blue Shield of California Commercial |
$65.17
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cigna of CA HMO |
$59.84
|
| Rate for Payer: Cigna of CA PPO |
$69.19
|
| 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 |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$79.47
|
| Rate for Payer: Global Benefits Group Commercial |
$56.10
|
| 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 |
$59.37
|
| 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 |
$22.44
|
| 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 |
$74.80
|
| Rate for Payer: Networks By Design Commercial |
$60.77
|
| Rate for Payer: Prime Health Services Commercial |
$79.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.10
|
| 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 SOP TPMT ENZYME
|
Facility
|
IP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$79.47 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.40
|
| Rate for Payer: EPIC Health Plan Senior |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$79.47
|
| Rate for Payer: Global Benefits Group Commercial |
$56.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.44
|
| Rate for Payer: Multiplan Commercial |
$74.80
|
| Rate for Payer: Networks By Design Commercial |
$60.77
|
| Rate for Payer: Prime Health Services Commercial |
$79.47
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$155.38 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.38
|
| Rate for Payer: Blue Shield of California Commercial |
$120.58
|
| Rate for Payer: Blue Shield of California Commercial |
$79.75
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOQ SARS-COV-2
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
|
|
HC SOQ SARS-COV-2
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$372.39 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.39
|
| Rate for Payer: Blue Shield of California Commercial |
$31.81
|
| Rate for Payer: Blue Shield of California Commercial |
$48.09
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cigna of CA HMO |
$44.16
|
| Rate for Payer: Cigna of CA PPO |
$51.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
