|
HC SOM ZINC URINE
|
Facility
|
OP
|
$185.52
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$166.97 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.82
|
| Rate for Payer: Blue Shield of California Commercial |
$112.61
|
| Rate for Payer: Blue Shield of California EPN |
$73.65
|
| Rate for Payer: Cash Price |
$185.52
|
| Rate for Payer: Cash Price |
$185.52
|
| Rate for Payer: Central Health Plan Commercial |
$148.42
|
| Rate for Payer: Cigna of CA HMO |
$118.73
|
| Rate for Payer: Cigna of CA PPO |
$137.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Senior |
$11.39
|
| Rate for Payer: Galaxy Health WC |
$157.69
|
| Rate for Payer: Global Benefits Group Commercial |
$111.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.39
|
| Rate for Payer: InnovAge PACE Commercial |
$17.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.26
|
| Rate for Payer: Multiplan Commercial |
$139.14
|
| Rate for Payer: Networks By Design Commercial |
$120.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$157.69
|
| Rate for Payer: Prime Health Services Medicare |
$12.07
|
| Rate for Payer: Riverside University Health System MISP |
$12.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.22
|
| Rate for Payer: United Healthcare All Other HMO |
$9.22
|
| Rate for Payer: United Healthcare HMO Rider |
$9.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
| Rate for Payer: Adventist Health Commercial |
$37.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.87
|
|
|
HC SOM ZINC URINE
|
Facility
|
IP
|
$185.52
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
900911153
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.10 |
| Max. Negotiated Rate |
$166.97 |
| Rate for Payer: Adventist Health Commercial |
$37.10
|
| Rate for Payer: Cash Price |
$185.52
|
| Rate for Payer: Central Health Plan Commercial |
$148.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.21
|
| Rate for Payer: EPIC Health Plan Senior |
$74.21
|
| Rate for Payer: Galaxy Health WC |
$157.69
|
| Rate for Payer: Global Benefits Group Commercial |
$111.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$139.14
|
| Rate for Payer: Networks By Design Commercial |
$120.59
|
| Rate for Payer: Prime Health Services Commercial |
$157.69
|
|
|
HC SOM ZONISAMIDE LEVEL
|
Facility
|
OP
|
$39.85
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$57.99 |
| Rate for Payer: Adventist Health Commercial |
$7.97
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.20
|
| 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 |
$24.19
|
| Rate for Payer: Blue Shield of California EPN |
$15.82
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Central Health Plan Commercial |
$31.88
|
| Rate for Payer: Cigna of CA HMO |
$25.50
|
| Rate for Payer: Cigna of CA PPO |
$29.49
|
| 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 |
$33.87
|
| Rate for Payer: Global Benefits Group Commercial |
$23.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.87
|
| 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 |
$26.58
|
| 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 |
$7.97
|
| 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 |
$29.89
|
| Rate for Payer: Networks By Design Commercial |
$25.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.25
|
| Rate for Payer: Prime Health Services Commercial |
$33.87
|
| 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 |
$23.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.91
|
| 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 ZONISAMIDE LEVEL
|
Facility
|
IP
|
$39.85
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
900912714
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Adventist Health Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$39.85
|
| Rate for Payer: Central Health Plan Commercial |
$31.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.94
|
| Rate for Payer: EPIC Health Plan Senior |
$15.94
|
| Rate for Payer: Galaxy Health WC |
$33.87
|
| Rate for Payer: Global Benefits Group Commercial |
$23.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.97
|
| Rate for Payer: Multiplan Commercial |
$29.89
|
| Rate for Payer: Networks By Design Commercial |
$25.90
|
| Rate for Payer: Prime Health Services Commercial |
$33.87
|
|
|
HC SON ASPARAGINASE ASSAY
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.00
|
| Rate for Payer: EPIC Health Plan Senior |
$86.00
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
|
|
HC SON ASPARAGINASE ASSAY
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900915353
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Adventist Health Commercial |
$43.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$130.50
|
| Rate for Payer: Blue Shield of California EPN |
$85.36
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Cash Price |
$118.25
|
| Rate for Payer: Central Health Plan Commercial |
$172.00
|
| Rate for Payer: Cigna of CA HMO |
$137.60
|
| Rate for Payer: Cigna of CA PPO |
$159.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$182.75
|
| Rate for Payer: Global Benefits Group Commercial |
$129.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: InnovAge PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$161.25
|
| Rate for Payer: Networks By Design Commercial |
$139.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$182.75
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SONGI 14011200 HCV PCR QL
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.72
|
| 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 |
$142.65
|
| Rate for Payer: Blue Shield of California EPN |
$93.30
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: Cigna of CA HMO |
$150.40
|
| Rate for Payer: Cigna of CA PPO |
$173.90
|
| 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 |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| 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 |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| 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 |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
| 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 |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.00
|
| 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 SONGI 14011200 HCV PCR QL
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 87521
|
| Hospital Charge Code |
900914766
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Adventist Health Commercial |
$47.00
|
| Rate for Payer: Cash Price |
$129.25
|
| Rate for Payer: Central Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.00
|
| Rate for Payer: EPIC Health Plan Senior |
$94.00
|
| Rate for Payer: Galaxy Health WC |
$199.75
|
| Rate for Payer: Global Benefits Group Commercial |
$141.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$176.25
|
| Rate for Payer: Networks By Design Commercial |
$152.75
|
| Rate for Payer: Prime Health Services Commercial |
$199.75
|
|
|
HC SOP CELIAC PLUS
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.14
|
| Rate for Payer: Blue Shield of California Commercial |
$77.39
|
| Rate for Payer: Blue Shield of California EPN |
$50.62
|
| Rate for Payer: Cash Price |
$70.12
|
| Rate for Payer: Cash Price |
$70.12
|
| Rate for Payer: Central Health Plan Commercial |
$102.00
|
| Rate for Payer: Cigna of CA HMO |
$81.60
|
| Rate for Payer: Cigna of CA PPO |
$94.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SOP CELIAC PLUS
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914910
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$70.12
|
| Rate for Payer: Central Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.00
|
| Rate for Payer: EPIC Health Plan Senior |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
IP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$248.62 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Cash Price |
$151.94
|
| Rate for Payer: Central Health Plan Commercial |
$221.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.50
|
| Rate for Payer: EPIC Health Plan Senior |
$110.50
|
| Rate for Payer: Galaxy Health WC |
$234.81
|
| Rate for Payer: Global Benefits Group Commercial |
$165.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.25
|
| Rate for Payer: Multiplan Commercial |
$207.19
|
| Rate for Payer: Networks By Design Commercial |
$179.56
|
| Rate for Payer: Prime Health Services Commercial |
$234.81
|
|
|
HC SOP CELIAC PLUS 81382
|
Facility
|
OP
|
$276.25
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
900914907
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$612.70 |
| Rate for Payer: Adventist Health Commercial |
$55.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$123.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.35
|
| Rate for Payer: Blue Shield of California Commercial |
$167.68
|
| Rate for Payer: Blue Shield of California EPN |
$109.67
|
| Rate for Payer: Cash Price |
$151.94
|
| Rate for Payer: Cash Price |
$151.94
|
| Rate for Payer: Central Health Plan Commercial |
$221.00
|
| Rate for Payer: Cigna of CA HMO |
$176.80
|
| Rate for Payer: Cigna of CA PPO |
$204.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$136.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.97
|
| Rate for Payer: EPIC Health Plan Senior |
$123.68
|
| Rate for Payer: Galaxy Health WC |
$234.81
|
| Rate for Payer: Global Benefits Group Commercial |
$165.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$202.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$189.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$123.68
|
| Rate for Payer: InnovAge PACE Commercial |
$185.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.73
|
| Rate for Payer: Multiplan Commercial |
$207.19
|
| Rate for Payer: Networks By Design Commercial |
$179.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$123.68
|
| Rate for Payer: Prime Health Services Commercial |
$234.81
|
| Rate for Payer: Prime Health Services Medicare |
$131.10
|
| Rate for Payer: Riverside University Health System MISP |
$136.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.18
|
| Rate for Payer: United Healthcare All Other HMO |
$100.18
|
| Rate for Payer: United Healthcare HMO Rider |
$100.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$123.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$136.05
|
| Rate for Payer: Vantage Medical Group Senior |
$123.68
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
OP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$56.37 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.44
|
| Rate for Payer: Blue Shield of California Commercial |
$12.90
|
| Rate for Payer: Blue Shield of California EPN |
$8.44
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Central Health Plan Commercial |
$17.01
|
| Rate for Payer: Cigna of CA HMO |
$13.61
|
| Rate for Payer: Cigna of CA PPO |
$15.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Senior |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$18.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: InnovAge PACE Commercial |
$13.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$15.95
|
| Rate for Payer: Networks By Design Commercial |
$13.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.07
|
| Rate for Payer: Prime Health Services Medicare |
$9.86
|
| Rate for Payer: Riverside University Health System MISP |
$10.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOP CELIAC PLUS 82784
|
Facility
|
IP
|
$21.26
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914909
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$19.13 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Central Health Plan Commercial |
$17.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.07
|
| Rate for Payer: Global Benefits Group Commercial |
$12.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$15.95
|
| Rate for Payer: Networks By Design Commercial |
$13.82
|
| Rate for Payer: Prime Health Services Commercial |
$18.07
|
|
|
HC SOP CELIAC PLUS 83520
|
Facility
|
OP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$19.78
|
| Rate for Payer: Blue Shield of California EPN |
$12.93
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Central Health Plan Commercial |
$26.06
|
| Rate for Payer: Cigna of CA HMO |
$20.85
|
| Rate for Payer: Cigna of CA PPO |
$24.11
|
| 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 |
$27.69
|
| Rate for Payer: Global Benefits Group Commercial |
$19.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.52
|
| 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 |
$24.43
|
| Rate for Payer: Networks By Design Commercial |
$21.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$27.69
|
| 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 |
$19.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.55
|
| 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 SOP CELIAC PLUS 83520
|
Facility
|
IP
|
$32.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914908
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.52 |
| Max. Negotiated Rate |
$29.32 |
| Rate for Payer: Adventist Health Commercial |
$6.52
|
| Rate for Payer: Cash Price |
$17.92
|
| Rate for Payer: Central Health Plan Commercial |
$26.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.03
|
| Rate for Payer: EPIC Health Plan Senior |
$13.03
|
| Rate for Payer: Galaxy Health WC |
$27.69
|
| Rate for Payer: Global Benefits Group Commercial |
$19.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.52
|
| Rate for Payer: Multiplan Commercial |
$24.43
|
| Rate for Payer: Networks By Design Commercial |
$21.18
|
| Rate for Payer: Prime Health Services Commercial |
$27.69
|
|
|
HC SOP CELIAC SEROLOGY
|
Facility
|
OP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.14
|
| Rate for Payer: Blue Shield of California Commercial |
$77.39
|
| Rate for Payer: Blue Shield of California EPN |
$50.62
|
| Rate for Payer: Cash Price |
$70.12
|
| Rate for Payer: Cash Price |
$70.12
|
| Rate for Payer: Central Health Plan Commercial |
$102.00
|
| Rate for Payer: Cigna of CA HMO |
$81.60
|
| Rate for Payer: Cigna of CA PPO |
$94.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SOP CELIAC SEROLOGY
|
Facility
|
IP
|
$127.50
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900914914
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$70.12
|
| Rate for Payer: Central Health Plan Commercial |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.00
|
| Rate for Payer: EPIC Health Plan Senior |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$108.38
|
| Rate for Payer: Global Benefits Group Commercial |
$76.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$114.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.50
|
| Rate for Payer: Multiplan Commercial |
$95.62
|
| Rate for Payer: Networks By Design Commercial |
$82.88
|
| Rate for Payer: Prime Health Services Commercial |
$108.38
|
|
|
HC SOP TPMT ENZYME
|
Facility
|
OP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$130.82 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$56.75
|
| Rate for Payer: Blue Shield of California EPN |
$37.12
|
| Rate for Payer: Cash Price |
$51.43
|
| Rate for Payer: Cash Price |
$51.43
|
| Rate for Payer: Central Health Plan Commercial |
$74.80
|
| Rate for Payer: Cigna of CA HMO |
$59.84
|
| Rate for Payer: Cigna of CA PPO |
$69.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$79.47
|
| Rate for Payer: Global Benefits Group Commercial |
$56.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: InnovAge PACE Commercial |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$70.12
|
| Rate for Payer: Networks By Design Commercial |
$60.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$79.47
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOP TPMT ENZYME
|
Facility
|
IP
|
$93.50
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914906
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Adventist Health Commercial |
$18.70
|
| Rate for Payer: Cash Price |
$51.43
|
| Rate for Payer: Central Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.40
|
| Rate for Payer: EPIC Health Plan Senior |
$37.40
|
| Rate for Payer: Galaxy Health WC |
$79.47
|
| Rate for Payer: Global Benefits Group Commercial |
$56.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$70.12
|
| Rate for Payer: Networks By Design Commercial |
$60.77
|
| Rate for Payer: Prime Health Services Commercial |
$79.47
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.23
|
| Rate for Payer: Blue Shield of California Commercial |
$105.01
|
| Rate for Payer: Blue Shield of California EPN |
$68.68
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: Cigna of CA HMO |
$110.72
|
| Rate for Payer: Cigna of CA PPO |
$128.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: InnovAge PACE Commercial |
$22.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Riverside University Health System MISP |
$16.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOQ 26477 ASPERG IGM 86606
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914876
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.60 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Adventist Health Commercial |
$34.60
|
| Rate for Payer: Cash Price |
$95.15
|
| Rate for Payer: Central Health Plan Commercial |
$138.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.20
|
| Rate for Payer: EPIC Health Plan Senior |
$69.20
|
| Rate for Payer: Galaxy Health WC |
$147.05
|
| Rate for Payer: Global Benefits Group Commercial |
$103.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.60
|
| Rate for Payer: Multiplan Commercial |
$129.75
|
| Rate for Payer: Networks By Design Commercial |
$112.45
|
| Rate for Payer: Prime Health Services Commercial |
$147.05
|
|
|
HC SOQ SARS-COV-2
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$262.47 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.27
|
| Rate for Payer: Blue Shield of California Commercial |
$41.88
|
| Rate for Payer: Blue Shield of California EPN |
$27.39
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Central Health Plan Commercial |
$55.20
|
| Rate for Payer: Cigna of CA HMO |
$44.16
|
| Rate for Payer: Cigna of CA PPO |
$51.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOQ SARS-COV-2
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913686
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Cash Price |
$37.95
|
| Rate for Payer: Central Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
|
|
HC SOSB MICRO ARTHROPOD EXAM
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
900915252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
