|
HC SOM TSH SENSITIVE, SERUM
|
Facility
|
IP
|
$24.06
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900913813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$21.65 |
| Rate for Payer: Adventist Health Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Central Health Plan Commercial |
$19.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.62
|
| Rate for Payer: EPIC Health Plan Senior |
$9.62
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$18.05
|
| Rate for Payer: Networks By Design Commercial |
$15.64
|
| Rate for Payer: Prime Health Services Commercial |
$20.45
|
|
|
HC SOM TTFB 84402A
|
Facility
|
IP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$72.99 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Central Health Plan Commercial |
$64.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.44
|
| Rate for Payer: EPIC Health Plan Senior |
$32.44
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$60.83
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
|
|
HC SOM TTFB 84402A
|
Facility
|
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$263.03 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.03
|
| Rate for Payer: Blue Shield of California Commercial |
$51.09
|
| Rate for Payer: Blue Shield of California EPN |
$32.20
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Central Health Plan Commercial |
$64.88
|
| Rate for Payer: Cigna of CA HMO |
$51.90
|
| Rate for Payer: Cigna of CA PPO |
$60.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.03
|
| Rate for Payer: EPIC Health Plan Senior |
$28.02
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$60.83
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.47
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
| Rate for Payer: Prime Health Services Medicare |
$27.00
|
| Rate for Payer: Riverside University Health System MISP |
$28.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.63
|
| Rate for Payer: United Healthcare All Other HMO |
$20.63
|
| Rate for Payer: United Healthcare HMO Rider |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TTFB 84402B
|
Facility
|
IP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$72.99 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Central Health Plan Commercial |
$64.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.44
|
| Rate for Payer: EPIC Health Plan Senior |
$32.44
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$60.83
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
|
|
HC SOM TTFB 84402B
|
Facility
|
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$263.03 |
| Rate for Payer: Adventist Health Commercial |
$16.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.03
|
| Rate for Payer: Blue Shield of California Commercial |
$51.09
|
| Rate for Payer: Blue Shield of California EPN |
$32.20
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Cash Price |
$81.10
|
| Rate for Payer: Central Health Plan Commercial |
$64.88
|
| Rate for Payer: Cigna of CA HMO |
$51.90
|
| Rate for Payer: Cigna of CA PPO |
$60.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.03
|
| Rate for Payer: EPIC Health Plan Senior |
$28.02
|
| Rate for Payer: Galaxy Health WC |
$68.94
|
| Rate for Payer: Global Benefits Group Commercial |
$48.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$60.83
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.47
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
| Rate for Payer: Prime Health Services Medicare |
$27.00
|
| Rate for Payer: Riverside University Health System MISP |
$28.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.63
|
| Rate for Payer: United Healthcare All Other HMO |
$20.63
|
| Rate for Payer: United Healthcare HMO Rider |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TTFB 84403
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$74.01 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Central Health Plan Commercial |
$65.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.89
|
| Rate for Payer: EPIC Health Plan Senior |
$32.89
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.45
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
|
|
HC SOM TTFB 84403
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900914764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$261.06 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.06
|
| Rate for Payer: Blue Shield of California Commercial |
$51.80
|
| Rate for Payer: Blue Shield of California EPN |
$32.65
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Central Health Plan Commercial |
$65.78
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$60.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Senior |
$28.39
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.81
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Riverside University Health System MISP |
$28.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM UBEMS 81406
|
Facility
|
IP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$870.75 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Central Health Plan Commercial |
$774.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$677.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.00
|
| Rate for Payer: EPIC Health Plan Senior |
$387.00
|
| Rate for Payer: Galaxy Health WC |
$822.38
|
| Rate for Payer: Global Benefits Group Commercial |
$580.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$870.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$570.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$725.62
|
| Rate for Payer: Networks By Design Commercial |
$628.88
|
| Rate for Payer: Prime Health Services Commercial |
$822.38
|
|
|
HC SOM UBEMS 81406
|
Facility
|
OP
|
$967.50
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914886
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$2,431.36 |
| Rate for Payer: Adventist Health Commercial |
$193.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$282.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,748.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,431.36
|
| Rate for Payer: Blue Shield of California Commercial |
$609.52
|
| Rate for Payer: Blue Shield of California EPN |
$384.10
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Cash Price |
$967.50
|
| Rate for Payer: Central Health Plan Commercial |
$774.00
|
| Rate for Payer: Cigna of CA HMO |
$619.20
|
| Rate for Payer: Cigna of CA PPO |
$715.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$677.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.75
|
| Rate for Payer: EPIC Health Plan Senior |
$311.17
|
| Rate for Payer: Galaxy Health WC |
$822.38
|
| Rate for Payer: Global Benefits Group Commercial |
$580.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$870.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$486.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$614.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$396.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$725.62
|
| Rate for Payer: Networks By Design Commercial |
$628.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$282.88
|
| Rate for Payer: Prime Health Services Commercial |
$822.38
|
| Rate for Payer: Prime Health Services Medicare |
$299.85
|
| Rate for Payer: Riverside University Health System MISP |
$311.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$580.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$580.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.63
|
| Rate for Payer: Blue Shield of California Commercial |
$224.91
|
| Rate for Payer: Blue Shield of California EPN |
$141.73
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Central Health Plan Commercial |
$285.60
|
| Rate for Payer: Cigna of CA HMO |
$228.48
|
| Rate for Payer: Cigna of CA PPO |
$264.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.31
|
| Rate for Payer: EPIC Health Plan Senior |
$20.21
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$321.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.62
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.37
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
| Rate for Payer: Prime Health Services Medicare |
$19.47
|
| Rate for Payer: Riverside University Health System MISP |
$20.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.88
|
| Rate for Payer: United Healthcare All Other HMO |
$14.88
|
| Rate for Payer: United Healthcare HMO Rider |
$14.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
HC SOM UNFRACT HEPARIN DEP PLT
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
900914710
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Central Health Plan Commercial |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$321.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.40
|
| Rate for Payer: Multiplan Commercial |
$267.75
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
|
IP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$247.93 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Central Health Plan Commercial |
$220.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.19
|
| Rate for Payer: EPIC Health Plan Senior |
$110.19
|
| Rate for Payer: Galaxy Health WC |
$234.16
|
| Rate for Payer: Global Benefits Group Commercial |
$165.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.10
|
| Rate for Payer: Multiplan Commercial |
$206.61
|
| Rate for Payer: Networks By Design Commercial |
$179.06
|
| Rate for Payer: Prime Health Services Commercial |
$234.16
|
|
|
HC SOM UNIPARENTAL DISOMY AMP
|
Facility
|
OP
|
$275.48
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
900914445
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$752.26 |
| Rate for Payer: Adventist Health Commercial |
$55.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$541.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$752.26
|
| Rate for Payer: Blue Shield of California Commercial |
$173.55
|
| Rate for Payer: Blue Shield of California EPN |
$109.37
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Central Health Plan Commercial |
$220.38
|
| Rate for Payer: Cigna of CA HMO |
$176.31
|
| Rate for Payer: Cigna of CA PPO |
$203.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.04
|
| Rate for Payer: EPIC Health Plan Senior |
$165.36
|
| Rate for Payer: Galaxy Health WC |
$234.16
|
| Rate for Payer: Global Benefits Group Commercial |
$165.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$258.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.44
|
| Rate for Payer: Multiplan Commercial |
$206.61
|
| Rate for Payer: Networks By Design Commercial |
$179.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.33
|
| Rate for Payer: Prime Health Services Commercial |
$234.16
|
| Rate for Payer: Prime Health Services Medicare |
$159.35
|
| Rate for Payer: Riverside University Health System MISP |
$165.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.77
|
| Rate for Payer: United Healthcare All Other HMO |
$121.77
|
| Rate for Payer: United Healthcare HMO Rider |
$121.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: Vantage Medical Group Senior |
$150.33
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| 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 |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| 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 |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| 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 |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM UREAPLASMA PCR
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
|
OP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.32
|
| Rate for Payer: Blue Shield of California Commercial |
$8.93
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
|
IP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: EPIC Health Plan Senior |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
|
IP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Central Health Plan Commercial |
$14.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
|
OP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$3.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| 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 |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$11.03
|
| Rate for Payer: Blue Shield of California EPN |
$6.95
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Central Health Plan Commercial |
$14.00
|
| Rate for Payer: Cigna of CA HMO |
$11.20
|
| Rate for Payer: Cigna of CA PPO |
$12.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
| 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 |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
|
OP
|
$53.71
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Adventist Health Commercial |
$10.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.84
|
| Rate for Payer: Blue Shield of California EPN |
$21.32
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Central Health Plan Commercial |
$42.97
|
| Rate for Payer: Cigna of CA HMO |
$34.37
|
| Rate for Payer: Cigna of CA PPO |
$39.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.29
|
| Rate for Payer: EPIC Health Plan Senior |
$38.86
|
| Rate for Payer: Galaxy Health WC |
$45.65
|
| Rate for Payer: Global Benefits Group Commercial |
$32.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.34
|
| Rate for Payer: Multiplan Commercial |
$40.28
|
| Rate for Payer: Networks By Design Commercial |
$34.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.33
|
| Rate for Payer: Prime Health Services Commercial |
$45.65
|
| Rate for Payer: Prime Health Services Medicare |
$37.45
|
| Rate for Payer: Riverside University Health System MISP |
$38.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.62
|
| Rate for Payer: United Healthcare All Other HMO |
$28.62
|
| Rate for Payer: United Healthcare HMO Rider |
$28.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Vantage Medical Group Senior |
$35.33
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
|
IP
|
$53.71
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Adventist Health Commercial |
$10.74
|
| Rate for Payer: Cash Price |
$53.71
|
| Rate for Payer: Central Health Plan Commercial |
$42.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.48
|
| Rate for Payer: EPIC Health Plan Senior |
$21.48
|
| Rate for Payer: Galaxy Health WC |
$45.65
|
| Rate for Payer: Global Benefits Group Commercial |
$32.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.74
|
| Rate for Payer: Multiplan Commercial |
$40.28
|
| Rate for Payer: Networks By Design Commercial |
$34.91
|
| Rate for Payer: Prime Health Services Commercial |
$45.65
|
|
|
HC SOM VDER 87529
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM VDER 87529
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| 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 |
$31.67
|
| Rate for Payer: Blue Shield of California EPN |
$19.96
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| 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 |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM VDER 87798
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| 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 |
$31.67
|
| Rate for Payer: Blue Shield of California EPN |
$19.96
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| 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 |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| 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 |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM VDER 87798
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
