|
HC SOM JAK 2 V617F MUTATION
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
900912994
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$351.80 |
| Rate for Payer: Adventist Health Commercial |
$20.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$91.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$351.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.40
|
| Rate for Payer: Blue Shield of California Commercial |
$61.71
|
| Rate for Payer: Blue Shield of California EPN |
$40.36
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Central Health Plan Commercial |
$81.33
|
| Rate for Payer: Cigna of CA HMO |
$65.06
|
| Rate for Payer: Cigna of CA PPO |
$75.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$91.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.74
|
| Rate for Payer: EPIC Health Plan Senior |
$91.66
|
| Rate for Payer: Galaxy Health WC |
$86.41
|
| Rate for Payer: Global Benefits Group Commercial |
$61.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$150.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$91.66
|
| Rate for Payer: InnovAge PACE Commercial |
$137.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122.82
|
| Rate for Payer: Multiplan Commercial |
$76.25
|
| Rate for Payer: Networks By Design Commercial |
$66.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$91.66
|
| Rate for Payer: Prime Health Services Commercial |
$86.41
|
| Rate for Payer: Prime Health Services Medicare |
$97.16
|
| Rate for Payer: Riverside University Health System MISP |
$100.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.24
|
| Rate for Payer: United Healthcare All Other HMO |
$74.24
|
| Rate for Payer: United Healthcare HMO Rider |
$74.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$91.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.83
|
| Rate for Payer: Vantage Medical Group Senior |
$91.66
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM JC VIRUS BY PCR
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912607
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.47
|
| 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 |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$39.45
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| 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: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| 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 |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| 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 KAPPA LIGHT CHAINS
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
|
|
HC SOM KAPPA LIGHT CHAINS
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910385
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$35.36 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.56
|
| 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 |
$35.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.18
|
| Rate for Payer: Blue Shield of California Commercial |
$9.56
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$11.65
|
| 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: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
| 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 |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: 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 KARYOTYPES GT 2
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$182.59 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$33.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4.55
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.00
|
| Rate for Payer: Cigna of CA HMO |
$4.80
|
| Rate for Payer: Cigna of CA PPO |
$5.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.18
|
| Rate for Payer: EPIC Health Plan Senior |
$33.47
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$54.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: InnovAge PACE Commercial |
$50.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33.47
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Medicare |
$35.48
|
| Rate for Payer: Riverside University Health System MISP |
$36.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC SOM KARYOTYPES GT 2
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900915302
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
|
|
HC SOM KPNRP 87798
|
Facility
|
IP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$142.16 |
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Central Health Plan Commercial |
$126.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.18
|
| Rate for Payer: EPIC Health Plan Senior |
$63.18
|
| Rate for Payer: Galaxy Health WC |
$134.26
|
| Rate for Payer: Global Benefits Group Commercial |
$94.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.59
|
| Rate for Payer: Multiplan Commercial |
$118.46
|
| Rate for Payer: Networks By Design Commercial |
$102.67
|
| Rate for Payer: Prime Health Services Commercial |
$134.26
|
|
|
HC SOM KPNRP 87798
|
Facility
|
OP
|
$157.95
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$31.59
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.92
|
| 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 |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$95.88
|
| Rate for Payer: Blue Shield of California EPN |
$62.71
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Cash Price |
$157.95
|
| Rate for Payer: Central Health Plan Commercial |
$126.36
|
| Rate for Payer: Cigna of CA HMO |
$101.09
|
| Rate for Payer: Cigna of CA PPO |
$116.88
|
| 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: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$134.26
|
| Rate for Payer: Global Benefits Group Commercial |
$94.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.16
|
| 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: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$118.46
|
| Rate for Payer: Networks By Design Commercial |
$102.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$134.26
|
| 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 |
$94.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.77
|
| 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 LACTOFERR DET EIA STOOL
|
Facility
|
OP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$86.60 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.44
|
| Rate for Payer: Blue Shield of California Commercial |
$58.41
|
| Rate for Payer: Blue Shield of California EPN |
$38.20
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: Cigna of CA HMO |
$61.58
|
| Rate for Payer: Cigna of CA PPO |
$71.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.59
|
| Rate for Payer: EPIC Health Plan Senior |
$19.70
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.70
|
| Rate for Payer: InnovAge PACE Commercial |
$29.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: Networks By Design Commercial |
$62.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.70
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
| Rate for Payer: Prime Health Services Medicare |
$20.88
|
| Rate for Payer: Riverside University Health System MISP |
$21.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.96
|
| Rate for Payer: United Healthcare All Other HMO |
$15.96
|
| Rate for Payer: United Healthcare HMO Rider |
$15.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.67
|
| Rate for Payer: Vantage Medical Group Senior |
$19.70
|
|
|
HC SOM LACTOFERR DET EIA STOOL
|
Facility
|
IP
|
$96.22
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
900914704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$86.60 |
| Rate for Payer: Adventist Health Commercial |
$19.24
|
| Rate for Payer: Cash Price |
$96.22
|
| Rate for Payer: Central Health Plan Commercial |
$76.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.49
|
| Rate for Payer: EPIC Health Plan Senior |
$38.49
|
| Rate for Payer: Galaxy Health WC |
$81.79
|
| Rate for Payer: Global Benefits Group Commercial |
$57.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.24
|
| Rate for Payer: Multiplan Commercial |
$72.17
|
| Rate for Payer: Networks By Design Commercial |
$62.54
|
| Rate for Payer: Prime Health Services Commercial |
$81.79
|
|
|
HC SOM LAMBDA LIGHT CHAINS
|
Facility
|
OP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$35.36 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.56
|
| 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 |
$35.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.18
|
| Rate for Payer: Blue Shield of California Commercial |
$9.56
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$10.08
|
| Rate for Payer: Cigna of CA PPO |
$11.65
|
| 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: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
| 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 |
$9.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: 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 LAMBDA LIGHT CHAINS
|
Facility
|
IP
|
$15.75
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
900910386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.39
|
| Rate for Payer: Global Benefits Group Commercial |
$9.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$11.81
|
| Rate for Payer: Networks By Design Commercial |
$10.24
|
| Rate for Payer: Prime Health Services Commercial |
$13.39
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
|
IP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Central Health Plan Commercial |
$11.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: EPIC Health Plan Senior |
$5.73
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
|
OP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$57.99 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$8.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Central Health Plan Commercial |
$11.46
|
| Rate for Payer: Cigna of CA HMO |
$9.16
|
| Rate for Payer: Cigna of CA PPO |
$10.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.25
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Riverside University Health System MISP |
$14.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LASIX
|
Facility
|
IP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Central Health Plan Commercial |
$95.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.71
|
| Rate for Payer: EPIC Health Plan Senior |
$47.71
|
| Rate for Payer: Galaxy Health WC |
$101.39
|
| Rate for Payer: Global Benefits Group Commercial |
$71.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$89.46
|
| Rate for Payer: Networks By Design Commercial |
$77.53
|
| Rate for Payer: Prime Health Services Commercial |
$101.39
|
|
|
HC SOM LASIX
|
Facility
|
OP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Adventist Health Commercial |
$23.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.50
|
| Rate for Payer: Blue Shield of California Commercial |
$72.40
|
| Rate for Payer: Blue Shield of California EPN |
$47.35
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Central Health Plan Commercial |
$95.42
|
| Rate for Payer: Cigna of CA HMO |
$76.34
|
| Rate for Payer: Cigna of CA PPO |
$88.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$101.39
|
| Rate for Payer: Global Benefits Group Commercial |
$71.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$89.46
|
| Rate for Payer: Networks By Design Commercial |
$77.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$101.39
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
OP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$43.79 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6.82
|
| Rate for Payer: Blue Shield of California EPN |
$4.46
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Senior |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: InnovAge PACE Commercial |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.04
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Medicare |
$6.40
|
| Rate for Payer: Riverside University Health System MISP |
$6.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
|
IP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM LD ISOENZYMES
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$92.96 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.81
|
| Rate for Payer: Blue Shield of California EPN |
$4.45
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.18
|
| Rate for Payer: Cigna of CA PPO |
$8.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.79
|
| Rate for Payer: Galaxy Health WC |
$9.54
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.79
|
| Rate for Payer: InnovAge PACE Commercial |
$19.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$8.41
|
| Rate for Payer: Networks By Design Commercial |
$7.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.79
|
| Rate for Payer: Prime Health Services Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Medicare |
$13.56
|
| Rate for Payer: Riverside University Health System MISP |
$14.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.36
|
| Rate for Payer: United Healthcare All Other HMO |
$10.36
|
| Rate for Payer: United Healthcare HMO Rider |
$10.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Vantage Medical Group Senior |
$12.79
|
|
|
HC SOM LD ISOENZYMES
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Adventist Health Commercial |
$2.24
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.54
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$8.41
|
| Rate for Payer: Networks By Design Commercial |
$7.29
|
| Rate for Payer: Prime Health Services Commercial |
$9.54
|
|
|
HC SOM LEAD BLOOD
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$88.06 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5.52
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Senior |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: InnovAge PACE Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.11
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM LEAD BLOOD
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC SOM LEAD URINE
|
Facility
|
IP
|
$174.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Adventist Health Commercial |
$34.96
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Central Health Plan Commercial |
$139.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.92
|
| Rate for Payer: EPIC Health Plan Senior |
$69.92
|
| Rate for Payer: Galaxy Health WC |
$148.58
|
| Rate for Payer: Global Benefits Group Commercial |
$104.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$131.10
|
| Rate for Payer: Networks By Design Commercial |
$113.62
|
| Rate for Payer: Prime Health Services Commercial |
$148.58
|
|
|
HC SOM LEAD URINE
|
Facility
|
OP
|
$174.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Adventist Health Commercial |
$34.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.87
|
| Rate for Payer: Blue Shield of California Commercial |
$106.10
|
| Rate for Payer: Blue Shield of California EPN |
$69.40
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Cash Price |
$174.80
|
| Rate for Payer: Central Health Plan Commercial |
$139.84
|
| Rate for Payer: Cigna of CA HMO |
$111.87
|
| Rate for Payer: Cigna of CA PPO |
$129.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Senior |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$148.58
|
| Rate for Payer: Global Benefits Group Commercial |
$104.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: InnovAge PACE Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$131.10
|
| Rate for Payer: Networks By Design Commercial |
$113.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.11
|
| Rate for Payer: Prime Health Services Commercial |
$148.58
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
