|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
OP
|
$107.03
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$90.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$65.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.87
|
| Rate for Payer: Blue Distinction Transplant |
$64.22
|
| Rate for Payer: Blue Shield of California Commercial |
$69.14
|
| Rate for Payer: Blue Shield of California EPN |
$54.80
|
| Rate for Payer: Cash Price |
$48.16
|
| Rate for Payer: Cash Price |
$48.16
|
| Rate for Payer: Cigna of CA HMO |
$68.50
|
| Rate for Payer: Cigna of CA PPO |
$79.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.80
|
| Rate for Payer: Dignity Health Media |
$7.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$90.98
|
| Rate for Payer: Global Benefits Group Commercial |
$64.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$80.27
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$12.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$85.62
|
| Rate for Payer: Networks By Design Commercial |
$69.57
|
| Rate for Payer: Prime Health Services Commercial |
$90.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO |
$6.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Vantage Medical Group Senior |
$7.87
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
IP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$235.41 |
| Rate for Payer: Cash Price |
$124.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.78
|
| Rate for Payer: Galaxy Health WC |
$235.41
|
| Rate for Payer: Global Benefits Group Commercial |
$166.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.47
|
| Rate for Payer: Multiplan Commercial |
$221.56
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$235.41
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
OP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.88 |
| Max. Negotiated Rate |
$235.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$176.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.45
|
| Rate for Payer: Blue Distinction Transplant |
$166.17
|
| Rate for Payer: Blue Shield of California Commercial |
$178.91
|
| Rate for Payer: Blue Shield of California EPN |
$141.80
|
| Rate for Payer: Cash Price |
$124.63
|
| Rate for Payer: Cash Price |
$124.63
|
| Rate for Payer: Cigna of CA HMO |
$177.25
|
| Rate for Payer: Cigna of CA PPO |
$204.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.41
|
| Rate for Payer: Dignity Health Media |
$235.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$110.78
|
| Rate for Payer: Galaxy Health WC |
$235.41
|
| Rate for Payer: Global Benefits Group Commercial |
$166.17
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$207.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.47
|
| Rate for Payer: Multiplan Commercial |
$221.56
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$235.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.41
|
| Rate for Payer: Vantage Medical Group Senior |
$235.41
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
OP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$313.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| 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 |
$313.26
|
| Rate for Payer: Blue Distinction Transplant |
$23.54
|
| Rate for Payer: Blue Shield of California Commercial |
$25.34
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$25.11
|
| Rate for Payer: Cigna of CA PPO |
$29.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$33.35
|
| Rate for Payer: Global Benefits Group Commercial |
$23.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.42
|
| 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 |
$31.38
|
| Rate for Payer: Networks By Design Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Commercial |
$33.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.54
|
| 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: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
IP
|
$39.23
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$33.35 |
| Rate for Payer: Cash Price |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.69
|
| Rate for Payer: Galaxy Health WC |
$33.35
|
| Rate for Payer: Global Benefits Group Commercial |
$23.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.42
|
| Rate for Payer: Multiplan Commercial |
$31.38
|
| Rate for Payer: Networks By Design Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Commercial |
$33.35
|
|
|
HC SOM HANDLING FEE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900913932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$89.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.49
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Media |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC SOM HIV 2 CONFIRM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86702
|
| Hospital Charge Code |
900911352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$125.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.30
|
| Rate for Payer: Blue Distinction Transplant |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.28
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.28
|
| Rate for Payer: Dignity Health Media |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.52
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.17
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.12
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.95
|
| Rate for Payer: United Healthcare All Other HMO |
$10.95
|
| Rate for Payer: United Healthcare HMO Rider |
$10.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.87
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC SOM INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
IP
|
$32.21
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$27.38 |
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$27.38
|
| Rate for Payer: Global Benefits Group Commercial |
$19.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.73
|
| Rate for Payer: Multiplan Commercial |
$25.77
|
| Rate for Payer: Networks By Design Commercial |
$20.94
|
| Rate for Payer: Prime Health Services Commercial |
$27.38
|
|
|
HC SOM INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
OP
|
$32.21
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$178.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$178.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.84
|
| Rate for Payer: Blue Distinction Transplant |
$19.33
|
| Rate for Payer: Blue Shield of California Commercial |
$20.81
|
| Rate for Payer: Blue Shield of California EPN |
$16.49
|
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: Cash Price |
$14.49
|
| Rate for Payer: Cigna of CA HMO |
$20.61
|
| Rate for Payer: Cigna of CA PPO |
$23.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.12
|
| Rate for Payer: Dignity Health Media |
$21.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.41
|
| Rate for Payer: Galaxy Health WC |
$27.38
|
| Rate for Payer: Global Benefits Group Commercial |
$19.33
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$35.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$34.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.69
|
| Rate for Payer: Multiplan Commercial |
$25.77
|
| Rate for Payer: Networks By Design Commercial |
$20.94
|
| Rate for Payer: Prime Health Services Commercial |
$27.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO |
$17.34
|
| Rate for Payer: United Healthcare HMO Rider |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Vantage Medical Group Senior |
$21.41
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| 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 |
$44.35
|
| Rate for Payer: Blue Distinction Transplant |
$9.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.17
|
| Rate for Payer: Blue Shield of California EPN |
$8.06
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$11.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Media |
$17.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| 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 |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.45
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.90
|
| 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 |
$44.35
|
| Rate for Payer: Blue Distinction Transplant |
$9.45
|
| Rate for Payer: Blue Shield of California Commercial |
$10.17
|
| Rate for Payer: Blue Shield of California EPN |
$8.06
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$11.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: Dignity Health Media |
$17.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Heritage Provider Network Transplant |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| 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 |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.45
|
| 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: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$12.60
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
|
|
HC SOM LIPASE BF
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$57.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.78
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Media |
$6.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$150.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.12
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Media |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.21
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.78
|
| Rate for Payer: Heritage Provider Network Transplant |
$34.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$34.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.56 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.28
|
| Rate for Payer: Blue Distinction Transplant |
$161.40
|
| Rate for Payer: Blue Shield of California Commercial |
$173.77
|
| Rate for Payer: Blue Shield of California EPN |
$137.73
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Media |
$18.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$201.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$156.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.63
|
| Rate for Payer: Blue Distinction Transplant |
$21.00
|
| Rate for Payer: Blue Shield of California Commercial |
$22.61
|
| Rate for Payer: Blue Shield of California EPN |
$17.92
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Media |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.42
|
| Rate for Payer: Blue Distinction Transplant |
$147.00
|
| Rate for Payer: Blue Shield of California Commercial |
$158.27
|
| Rate for Payer: Blue Shield of California EPN |
$125.44
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Media |
$18.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.28
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$183.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.98
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Vantage Medical Group Senior |
$18.28
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC SOM SOTALOL
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.86
|
| Rate for Payer: Blue Distinction Transplant |
$49.34
|
| Rate for Payer: Blue Shield of California Commercial |
$53.12
|
| Rate for Payer: Blue Shield of California EPN |
$42.10
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$60.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Media |
$18.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$65.78
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SOTALOL
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.89
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.33
|
| 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 SPCL TRT PROC LG SGL RAD DOSE
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
909100313
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,064.40 |
| Max. Negotiated Rate |
$3,769.75 |
| Rate for Payer: Cash Price |
$1,995.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.00
|
| Rate for Payer: Galaxy Health WC |
$3,769.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,689.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.40
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: Networks By Design Commercial |
$2,882.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,769.75
|
|
