|
HC SOM TOXOPLASMA AB CSF IGG
|
Facility
|
IP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Central Health Plan Commercial |
$69.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.94
|
| Rate for Payer: EPIC Health Plan Senior |
$34.94
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
| Rate for Payer: Networks By Design Commercial |
$56.78
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
|
|
HC SOM TOXOPLASMA AB CSF IGG
|
Facility
|
OP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$145.10 |
| Rate for Payer: Adventist Health Commercial |
$17.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.10
|
| Rate for Payer: Blue Shield of California Commercial |
$55.04
|
| Rate for Payer: Blue Shield of California EPN |
$34.68
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Central Health Plan Commercial |
$69.89
|
| Rate for Payer: Cigna of CA HMO |
$55.91
|
| Rate for Payer: Cigna of CA PPO |
$64.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.83
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
| Rate for Payer: Networks By Design Commercial |
$56.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.39
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
|
OP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$150.62 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.62
|
| Rate for Payer: Blue Shield of California Commercial |
$55.12
|
| Rate for Payer: Blue Shield of California EPN |
$34.73
|
| Rate for Payer: Cash Price |
$87.49
|
| Rate for Payer: Cash Price |
$87.49
|
| Rate for Payer: Central Health Plan Commercial |
$69.99
|
| Rate for Payer: Cigna of CA HMO |
$55.99
|
| Rate for Payer: Cigna of CA PPO |
$64.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.85
|
| Rate for Payer: Galaxy Health WC |
$74.37
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: Networks By Design Commercial |
$56.87
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.41
|
| Rate for Payer: Prime Health Services Commercial |
$74.37
|
| Rate for Payer: Prime Health Services Medicare |
$15.27
|
| Rate for Payer: Riverside University Health System MISP |
$15.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
|
IP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$78.74 |
| Rate for Payer: Adventist Health Commercial |
$17.50
|
| Rate for Payer: Cash Price |
$87.49
|
| Rate for Payer: Central Health Plan Commercial |
$69.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.00
|
| Rate for Payer: EPIC Health Plan Senior |
$35.00
|
| Rate for Payer: Galaxy Health WC |
$74.37
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: Networks By Design Commercial |
$56.87
|
| Rate for Payer: Prime Health Services Commercial |
$74.37
|
|
|
HC SOM TOXOPLASMA GONDII BY PCR
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
|
|
HC SOM TOXOPLASMA GONDII BY PCR
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| 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 Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$59.22
|
| Rate for Payer: Blue Shield of California EPN |
$37.32
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$60.16
|
| Rate for Payer: Cigna of CA PPO |
$69.56
|
| 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 |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM TPMT
|
Facility
|
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.34
|
| Rate for Payer: EPIC Health Plan Senior |
$10.34
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
|
|
HC SOM TPMT
|
Facility
|
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| 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 Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$16.29
|
| Rate for Payer: Blue Shield of California EPN |
$10.27
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA PPO |
$19.14
|
| 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 |
$18.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.42
|
| 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 |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.52
|
| 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 SOM TPMT ACTIVITY PROFILE
|
Facility
|
IP
|
$155.25
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$139.72 |
| Rate for Payer: Adventist Health Commercial |
$31.05
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.10
|
| Rate for Payer: EPIC Health Plan Senior |
$62.10
|
| Rate for Payer: Galaxy Health WC |
$131.96
|
| Rate for Payer: Global Benefits Group Commercial |
$93.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$116.44
|
| Rate for Payer: Networks By Design Commercial |
$100.91
|
| Rate for Payer: Prime Health Services Commercial |
$131.96
|
|
|
HC SOM TPMT ACTIVITY PROFILE
|
Facility
|
OP
|
$155.25
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$141.56 |
| Rate for Payer: Adventist Health Commercial |
$31.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.60
|
| 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 Exchange |
$101.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.56
|
| Rate for Payer: Blue Shield of California Commercial |
$97.81
|
| Rate for Payer: Blue Shield of California EPN |
$61.63
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Cash Price |
$155.25
|
| Rate for Payer: Central Health Plan Commercial |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$99.36
|
| Rate for Payer: Cigna of CA PPO |
$114.89
|
| 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 |
$108.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$131.96
|
| Rate for Payer: Global Benefits Group Commercial |
$93.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$116.44
|
| Rate for Payer: Networks By Design Commercial |
$100.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$131.96
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.15
|
| 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 SOM TPPA 86780
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: EPIC Health Plan Senior |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC SOM TPPA 86780
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$175.47 |
| Rate for Payer: Adventist Health Commercial |
$6.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.47
|
| Rate for Payer: Blue Shield of California Commercial |
$20.16
|
| Rate for Payer: Blue Shield of California EPN |
$12.70
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.85
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Riverside University Health System MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM TPPTL 82657
|
Facility
|
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.34
|
| Rate for Payer: EPIC Health Plan Senior |
$10.34
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
|
|
HC SOM TPPTL 82657
|
Facility
|
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| 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 Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$16.29
|
| Rate for Payer: Blue Shield of California EPN |
$10.27
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Cash Price |
$25.86
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA PPO |
$19.14
|
| 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 |
$18.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.42
|
| 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 |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$19.39
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.52
|
| 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 SOM TRAM 83925
|
Facility
|
OP
|
$41.20
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$188.75 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.75
|
| Rate for Payer: Blue Shield of California Commercial |
$25.96
|
| Rate for Payer: Blue Shield of California EPN |
$16.36
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Central Health Plan Commercial |
$32.96
|
| Rate for Payer: Cigna of CA HMO |
$26.37
|
| Rate for Payer: Cigna of CA PPO |
$30.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.48
|
| Rate for Payer: EPIC Health Plan Senior |
$16.48
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
| Rate for Payer: Riverside University Health System MISP |
$16.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.60
|
| Rate for Payer: United Healthcare All Other HMO |
$20.60
|
| Rate for Payer: United Healthcare HMO Rider |
$20.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.02
|
| Rate for Payer: Vantage Medical Group Senior |
$35.02
|
|
|
HC SOM TRAM 83925
|
Facility
|
IP
|
$41.20
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$37.08 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Central Health Plan Commercial |
$32.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.48
|
| Rate for Payer: EPIC Health Plan Senior |
$16.48
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
900912640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$60.13 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.51
|
| Rate for Payer: Blue Shield of California EPN |
$5.36
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$8.64
|
| Rate for Payer: Cigna of CA PPO |
$9.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
900912640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
|
|
HC SOM TREE4 86003
|
Facility
|
OP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$38.51
|
| Rate for Payer: Blue Shield of California EPN |
$24.27
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Central Health Plan Commercial |
$48.90
|
| Rate for Payer: Cigna of CA HMO |
$39.12
|
| Rate for Payer: Cigna of CA PPO |
$45.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$51.96
|
| Rate for Payer: Global Benefits Group Commercial |
$36.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$45.85
|
| Rate for Payer: Networks By Design Commercial |
$39.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$51.96
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM TREE4 86003
|
Facility
|
IP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$55.02 |
| Rate for Payer: Adventist Health Commercial |
$12.23
|
| Rate for Payer: Cash Price |
$61.13
|
| Rate for Payer: Central Health Plan Commercial |
$48.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.45
|
| Rate for Payer: EPIC Health Plan Senior |
$24.45
|
| Rate for Payer: Galaxy Health WC |
$51.96
|
| Rate for Payer: Global Benefits Group Commercial |
$36.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$45.85
|
| Rate for Payer: Networks By Design Commercial |
$39.73
|
| Rate for Payer: Prime Health Services Commercial |
$51.96
|
|
|
HC SOM TRSF 84466
|
Facility
|
OP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$132.91 |
| Rate for Payer: Adventist Health Commercial |
$5.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.91
|
| Rate for Payer: Blue Shield of California Commercial |
$17.19
|
| Rate for Payer: Blue Shield of California EPN |
$10.83
|
| Rate for Payer: Cash Price |
$27.28
|
| Rate for Payer: Cash Price |
$27.28
|
| Rate for Payer: Central Health Plan Commercial |
$21.82
|
| Rate for Payer: Cigna of CA HMO |
$17.46
|
| Rate for Payer: Cigna of CA PPO |
$20.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.05
|
| Rate for Payer: EPIC Health Plan Senior |
$14.04
|
| Rate for Payer: Galaxy Health WC |
$23.19
|
| Rate for Payer: Global Benefits Group Commercial |
$16.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$17.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.76
|
| Rate for Payer: Prime Health Services Commercial |
$23.19
|
| Rate for Payer: Prime Health Services Medicare |
$13.53
|
| Rate for Payer: Riverside University Health System MISP |
$14.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC SOM TRSF 84466
|
Facility
|
IP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$24.55 |
| Rate for Payer: Adventist Health Commercial |
$5.46
|
| Rate for Payer: Cash Price |
$27.28
|
| Rate for Payer: Central Health Plan Commercial |
$21.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$10.91
|
| Rate for Payer: Galaxy Health WC |
$23.19
|
| Rate for Payer: Global Benefits Group Commercial |
$16.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$17.73
|
| Rate for Payer: Prime Health Services Commercial |
$23.19
|
|
|
HC SOM TRYPTASE
|
Facility
|
OP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| 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 Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$23.75
|
| Rate for Payer: Blue Shield of California EPN |
$14.97
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Central Health Plan Commercial |
$30.16
|
| Rate for Payer: Cigna of CA HMO |
$24.13
|
| Rate for Payer: Cigna of CA PPO |
$27.90
|
| 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 |
$26.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$32.05
|
| Rate for Payer: Global Benefits Group Commercial |
$22.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.94
|
| 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 |
$7.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$32.05
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.62
|
| 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 SOM TRYPTASE
|
Facility
|
IP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$33.93 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.70
|
| Rate for Payer: Central Health Plan Commercial |
$30.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.08
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$32.05
|
| Rate for Payer: Global Benefits Group Commercial |
$22.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| Rate for Payer: Multiplan Commercial |
$28.27
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$32.05
|
|
|
HC SOM TSH SENSITIVE, SERUM
|
Facility
|
OP
|
$24.06
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900913813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$169.95 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.95
|
| Rate for Payer: Blue Shield of California Commercial |
$15.16
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Central Health Plan Commercial |
$19.25
|
| Rate for Payer: Cigna of CA HMO |
$15.40
|
| Rate for Payer: Cigna of CA PPO |
$17.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.72
|
| Rate for Payer: EPIC Health Plan Senior |
$18.48
|
| Rate for Payer: Galaxy Health WC |
$20.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$18.05
|
| Rate for Payer: Networks By Design Commercial |
$15.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.80
|
| Rate for Payer: Prime Health Services Commercial |
$20.45
|
| Rate for Payer: Prime Health Services Medicare |
$17.81
|
| Rate for Payer: Riverside University Health System MISP |
$18.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
