|
HC SOM TRAM 83925
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM TRAM 83925
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
900915271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.60
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: IEHP medi-cal |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health MISP |
$18.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
IP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
|
|
HC SOM TRANSGLUTAMINASE AB IGG
|
Facility
OP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare 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 |
$207.60
|
| Rate for Payer: BCBS Transplant Transplant |
$8.85
|
| Rate for Payer: Blue Shield of California Commercial |
$9.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.17
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: Cigna of CA HMO |
$9.44
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: IEHP medi-cal |
$19.02
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Innovage PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.85
|
| Rate for Payer: Riverside University Health MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.85
|
| 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: 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 TREE4 86003
|
Facility
OP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: BCBS Transplant Transplant |
$36.68
|
| Rate for Payer: Blue Shield of California Commercial |
$37.78
|
| Rate for Payer: Blue Shield of California EPN |
$29.71
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Central Health Plan Commercial |
$48.90
|
| Rate for Payer: Cigna of CA HMO |
$39.12
|
| Rate for Payer: Cigna of CA PPO |
$45.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$51.96
|
| Rate for Payer: Global Benefits Group Commercial |
$36.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$45.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: IEHP medi-cal |
$8.61
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Innovage PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$45.85
|
| Rate for Payer: Networks By Design Commercial |
$39.73
|
| Rate for Payer: Prime Health Services Commercial |
$51.96
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$36.68
|
| Rate for Payer: Riverside University Health MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM TREE4 86003
|
Facility
IP
|
$61.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914815
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$55.02 |
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Central Health Plan Commercial |
$48.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.45
|
| Rate for Payer: Galaxy Health WC |
$51.96
|
| Rate for Payer: Global Benefits Group Commercial |
$36.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$45.85
|
| Rate for Payer: Networks By Design Commercial |
$39.73
|
| Rate for Payer: Prime Health Services Commercial |
$51.96
|
|
|
HC SOM TRSF 84466
|
Facility
IP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$24.55 |
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Central Health Plan Commercial |
$21.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: Galaxy Health WC |
$23.19
|
| Rate for Payer: Global Benefits Group Commercial |
$16.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$17.73
|
| Rate for Payer: Prime Health Services Commercial |
$23.19
|
|
|
HC SOM TRSF 84466
|
Facility
OP
|
$27.28
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
900914761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$116.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.61
|
| Rate for Payer: BCBS Transplant Transplant |
$16.37
|
| Rate for Payer: Blue Shield of California Commercial |
$16.86
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Caremore Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Central Health Plan Commercial |
$21.82
|
| Rate for Payer: Cigna of CA HMO |
$17.46
|
| Rate for Payer: Cigna of CA PPO |
$20.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.23
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.76
|
| Rate for Payer: Galaxy Health WC |
$23.19
|
| Rate for Payer: Global Benefits Group Commercial |
$16.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.93
|
| Rate for Payer: IEHP medi-cal |
$21.05
|
| Rate for Payer: IEHP Medicare Advantage |
$12.76
|
| Rate for Payer: Innovage PACE Commercial |
$19.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.10
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$17.73
|
| Rate for Payer: Prime Health Services Commercial |
$23.19
|
| Rate for Payer: Prime Health Services Medicare |
$13.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.37
|
| Rate for Payer: Riverside University Health MISP |
$14.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.04
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC SOM TRYPTASE
|
Facility
OP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: BCBS Transplant Transplant |
$22.62
|
| Rate for Payer: Blue Shield of California Commercial |
$23.30
|
| Rate for Payer: Blue Shield of California EPN |
$18.32
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Central Health Plan Commercial |
$30.16
|
| Rate for Payer: Cigna of CA HMO |
$24.13
|
| Rate for Payer: Cigna of CA PPO |
$27.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$32.04
|
| Rate for Payer: Global Benefits Group Commercial |
$22.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| 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 |
$28.28
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$32.04
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.62
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM TRYPTASE
|
Facility
IP
|
$37.70
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$33.93 |
| Rate for Payer: Cash Price |
$16.97
|
| Rate for Payer: Central Health Plan Commercial |
$30.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$32.04
|
| Rate for Payer: Global Benefits Group Commercial |
$22.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.54
|
| Rate for Payer: Multiplan Commercial |
$28.28
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$32.04
|
|
|
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: Cash Price |
$10.83
|
| Rate for Payer: Central Health Plan Commercial |
$19.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$16.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
| Rate for Payer: Networks By Design Commercial |
$15.64
|
| Rate for Payer: Prime Health Services Commercial |
$20.45
|
|
|
HC SOM TSH SENSITIVE, SERUM
|
Facility
OP
|
$24.06
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
900913813
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$149.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.11
|
| Rate for Payer: BCBS Transplant Transplant |
$14.44
|
| Rate for Payer: Blue Shield of California Commercial |
$14.87
|
| Rate for Payer: Blue Shield of California EPN |
$11.69
|
| Rate for Payer: Caremore Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: Central Health Plan Commercial |
$19.25
|
| Rate for Payer: Cigna of CA HMO |
$15.40
|
| Rate for Payer: Cigna of CA PPO |
$17.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$18.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.55
|
| Rate for Payer: IEHP medi-cal |
$27.72
|
| Rate for Payer: IEHP Medicare Advantage |
$16.80
|
| Rate for Payer: Innovage PACE Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$18.04
|
| Rate for Payer: Networks By Design Commercial |
$15.64
|
| Rate for Payer: Prime Health Services Commercial |
$20.45
|
| Rate for Payer: Prime Health Services Medicare |
$17.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.44
|
| Rate for Payer: Riverside University Health MISP |
$18.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
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: Cash Price |
$36.50
|
| Rate for Payer: Central Health Plan Commercial |
$64.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
| 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 |
$230.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: AlphaCare 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 |
$230.78
|
| Rate for Payer: BCBS Transplant Transplant |
$48.66
|
| Rate for Payer: Blue Shield of California Commercial |
$50.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.41
|
| Rate for Payer: Caremore Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| 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: EPIC Health Plan Commercial |
$34.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.47
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$60.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.77
|
| Rate for Payer: IEHP medi-cal |
$42.03
|
| Rate for Payer: IEHP Medicare Advantage |
$25.47
|
| Rate for Payer: Innovage PACE Commercial |
$38.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
| Rate for Payer: Prime Health Services Medicare |
$27.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$48.66
|
| Rate for Payer: Riverside University Health 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: 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
OP
|
$81.10
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900914763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$230.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: AlphaCare 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 |
$230.78
|
| Rate for Payer: BCBS Transplant Transplant |
$48.66
|
| Rate for Payer: Blue Shield of California Commercial |
$50.12
|
| Rate for Payer: Blue Shield of California EPN |
$39.41
|
| Rate for Payer: Caremore Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| 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: EPIC Health Plan Commercial |
$34.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.47
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$60.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.77
|
| Rate for Payer: IEHP medi-cal |
$42.03
|
| Rate for Payer: IEHP Medicare Advantage |
$25.47
|
| Rate for Payer: Innovage PACE Commercial |
$38.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
| Rate for Payer: Prime Health Services Medicare |
$27.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$48.66
|
| Rate for Payer: Riverside University Health 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: 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: Cash Price |
$36.50
|
| Rate for Payer: Central Health Plan Commercial |
$64.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$54.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.22
|
| Rate for Payer: Multiplan Commercial |
$60.82
|
| Rate for Payer: Networks By Design Commercial |
$52.72
|
| Rate for Payer: Prime Health Services Commercial |
$68.94
|
|
|
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: Cash Price |
$37.00
|
| Rate for Payer: Central Health Plan Commercial |
$65.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.89
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| 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 |
$229.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: AlphaCare 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 |
$229.04
|
| Rate for Payer: BCBS Transplant Transplant |
$49.34
|
| Rate for Payer: Blue Shield of California Commercial |
$50.82
|
| Rate for Payer: Blue Shield of California EPN |
$39.96
|
| Rate for Payer: Caremore Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| 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: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.81
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$61.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: IEHP medi-cal |
$42.59
|
| Rate for Payer: IEHP Medicare Advantage |
$25.81
|
| Rate for Payer: Innovage PACE Commercial |
$38.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: Riverside University Health 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: 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: Cash Price |
$435.38
|
| Rate for Payer: Central Health Plan Commercial |
$774.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$645.32
|
| 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 |
$2,133.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$282.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: AlphaCare 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 |
$2,133.20
|
| Rate for Payer: BCBS Transplant Transplant |
$580.50
|
| Rate for Payer: Blue Shield of California Commercial |
$597.92
|
| Rate for Payer: Blue Shield of California EPN |
$470.20
|
| Rate for Payer: Caremore Medicare Advantage |
$282.88
|
| Rate for Payer: Cash Price |
$435.38
|
| Rate for Payer: Cash Price |
$435.38
|
| 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: EPIC Health Plan Commercial |
$381.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$282.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$282.88
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$725.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: IEHP medi-cal |
$466.75
|
| Rate for Payer: IEHP Medicare Advantage |
$282.88
|
| Rate for Payer: Innovage PACE Commercial |
$424.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$645.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$299.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$580.50
|
| Rate for Payer: Riverside University Health 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: 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
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: Cash Price |
$160.65
|
| Rate for Payer: Central Health Plan Commercial |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$238.12
|
| 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 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 Medi-Cal |
$18.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: AlphaCare 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 |
$138.30
|
| Rate for Payer: BCBS Transplant Transplant |
$214.20
|
| Rate for Payer: Blue Shield of California Commercial |
$220.63
|
| Rate for Payer: Blue Shield of California EPN |
$173.50
|
| Rate for Payer: Caremore Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| 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 |
$27.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.37
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$267.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.13
|
| Rate for Payer: IEHP medi-cal |
$30.31
|
| Rate for Payer: IEHP Medicare Advantage |
$18.37
|
| Rate for Payer: Innovage PACE Commercial |
$27.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.62
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$19.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$214.20
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$27.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.21
|
| Rate for Payer: Vantage Medical Group Senior |
$18.37
|
|
|
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 |
$660.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$150.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$225.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.36
|
| Rate for Payer: AlphaCare 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 |
$660.01
|
| Rate for Payer: BCBS Transplant Transplant |
$165.29
|
| Rate for Payer: Blue Shield of California Commercial |
$170.25
|
| Rate for Payer: Blue Shield of California EPN |
$133.88
|
| Rate for Payer: Caremore Medicare Advantage |
$150.33
|
| Rate for Payer: Cash Price |
$123.97
|
| Rate for Payer: Cash Price |
$123.97
|
| 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: EPIC Health Plan Commercial |
$202.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$150.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$150.33
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$206.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.54
|
| Rate for Payer: IEHP medi-cal |
$248.04
|
| Rate for Payer: IEHP Medicare Advantage |
$150.33
|
| Rate for Payer: Innovage PACE Commercial |
$225.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.44
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$159.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$165.29
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$123.97
|
| Rate for Payer: Central Health Plan Commercial |
$220.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$183.75
|
| 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 UREAPLASMA PCR
|
Facility
IP
|
$37.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$33.75 |
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Central Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.00
|
| Rate for Payer: Galaxy Health WC |
$31.88
|
| Rate for Payer: Global Benefits Group Commercial |
$22.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$28.12
|
| Rate for Payer: Networks By Design Commercial |
$24.38
|
| Rate for Payer: Prime Health Services Commercial |
$31.88
|
|
