|
HC SOM 22FP 88271 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.69
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
|
|
HC SOM 22FP 88271 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914753
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$1,715.87 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,715.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.63
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: Cigna of CA HMO |
$12.30
|
| Rate for Payer: Cigna of CA PPO |
$14.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 22FP 88271 SINGLE
|
Facility
|
IP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$17.51 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Central Health Plan Commercial |
$15.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.78
|
| Rate for Payer: EPIC Health Plan Senior |
$7.78
|
| Rate for Payer: Galaxy Health WC |
$16.54
|
| Rate for Payer: Global Benefits Group Commercial |
$11.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
| Rate for Payer: Networks By Design Commercial |
$12.65
|
| Rate for Payer: Prime Health Services Commercial |
$16.54
|
|
|
HC SOM 22FP 88271 SINGLE
|
Facility
|
OP
|
$19.46
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914752
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$1,715.87 |
| Rate for Payer: Adventist Health Commercial |
$3.89
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,715.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.26
|
| Rate for Payer: Blue Shield of California EPN |
$7.73
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Cash Price |
$19.46
|
| Rate for Payer: Central Health Plan Commercial |
$15.57
|
| Rate for Payer: Cigna of CA HMO |
$12.45
|
| Rate for Payer: Cigna of CA PPO |
$14.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$16.54
|
| Rate for Payer: Global Benefits Group Commercial |
$11.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$14.60
|
| Rate for Payer: Networks By Design Commercial |
$12.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$16.54
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 22FP 88275 MULTIPLE
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$2,647.34 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,647.34
|
| Rate for Payer: Blue Shield of California Commercial |
$12.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.63
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: Cigna of CA HMO |
$12.30
|
| Rate for Payer: Cigna of CA PPO |
$14.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.19
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 22FP 88275 MULTIPLE
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914754
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.69
|
| Rate for Payer: Galaxy Health WC |
$16.34
|
| Rate for Payer: Global Benefits Group Commercial |
$11.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$14.41
|
| Rate for Payer: Networks By Design Commercial |
$12.49
|
| Rate for Payer: Prime Health Services Commercial |
$16.34
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
IP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$253.58 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Central Health Plan Commercial |
$225.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.70
|
| Rate for Payer: EPIC Health Plan Senior |
$112.70
|
| Rate for Payer: Galaxy Health WC |
$239.50
|
| Rate for Payer: Global Benefits Group Commercial |
$169.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$166.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.35
|
| Rate for Payer: Multiplan Commercial |
$211.32
|
| Rate for Payer: Networks By Design Commercial |
$183.14
|
| Rate for Payer: Prime Health Services Commercial |
$239.50
|
|
|
HC SOM 26 ADD FISH PROB 100-300
|
Facility
|
OP
|
$281.76
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914714
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$2,647.34 |
| Rate for Payer: Adventist Health Commercial |
$56.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,647.34
|
| Rate for Payer: Blue Shield of California Commercial |
$177.51
|
| Rate for Payer: Blue Shield of California EPN |
$111.86
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Cash Price |
$281.76
|
| Rate for Payer: Central Health Plan Commercial |
$225.41
|
| Rate for Payer: Cigna of CA HMO |
$180.33
|
| Rate for Payer: Cigna of CA PPO |
$208.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$197.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$239.50
|
| Rate for Payer: Global Benefits Group Commercial |
$169.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$211.32
|
| Rate for Payer: Networks By Design Commercial |
$183.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.19
|
| Rate for Payer: Prime Health Services Commercial |
$239.50
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
IP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$92.63 |
| Max. Negotiated Rate |
$416.83 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Central Health Plan Commercial |
$370.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$324.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.26
|
| Rate for Payer: EPIC Health Plan Senior |
$185.26
|
| Rate for Payer: Galaxy Health WC |
$393.67
|
| Rate for Payer: Global Benefits Group Commercial |
$277.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$416.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$273.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.63
|
| Rate for Payer: Multiplan Commercial |
$347.36
|
| Rate for Payer: Networks By Design Commercial |
$301.04
|
| Rate for Payer: Prime Health Services Commercial |
$393.67
|
|
|
HC SOM 26 ADD FISH PROBES
|
Facility
|
OP
|
$463.14
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914713
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,715.87 |
| Rate for Payer: Adventist Health Commercial |
$92.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,715.87
|
| Rate for Payer: Blue Shield of California Commercial |
$291.78
|
| Rate for Payer: Blue Shield of California EPN |
$183.87
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Cash Price |
$463.14
|
| Rate for Payer: Central Health Plan Commercial |
$370.51
|
| Rate for Payer: Cigna of CA HMO |
$296.41
|
| Rate for Payer: Cigna of CA PPO |
$342.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$324.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$393.67
|
| Rate for Payer: Global Benefits Group Commercial |
$277.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$416.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$294.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$347.36
|
| Rate for Payer: Networks By Design Commercial |
$301.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$393.67
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$277.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$277.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
OP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$2,647.34 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,647.34
|
| Rate for Payer: Blue Shield of California Commercial |
$190.66
|
| Rate for Payer: Blue Shield of California EPN |
$120.15
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Central Health Plan Commercial |
$242.11
|
| Rate for Payer: Cigna of CA HMO |
$193.69
|
| Rate for Payer: Cigna of CA PPO |
$223.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$257.24
|
| Rate for Payer: Global Benefits Group Commercial |
$181.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$226.98
|
| Rate for Payer: Networks By Design Commercial |
$196.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.19
|
| Rate for Payer: Prime Health Services Commercial |
$257.24
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM 28 ADD FISH PROB 100-300
|
Facility
|
IP
|
$302.64
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914712
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$60.53 |
| Max. Negotiated Rate |
$272.38 |
| Rate for Payer: Adventist Health Commercial |
$60.53
|
| Rate for Payer: Cash Price |
$302.64
|
| Rate for Payer: Central Health Plan Commercial |
$242.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.06
|
| Rate for Payer: EPIC Health Plan Senior |
$121.06
|
| Rate for Payer: Galaxy Health WC |
$257.24
|
| Rate for Payer: Global Benefits Group Commercial |
$181.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$272.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$192.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.53
|
| Rate for Payer: Multiplan Commercial |
$226.98
|
| Rate for Payer: Networks By Design Commercial |
$196.72
|
| Rate for Payer: Prime Health Services Commercial |
$257.24
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
IP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$99.51 |
| Max. Negotiated Rate |
$447.80 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Central Health Plan Commercial |
$398.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$348.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.02
|
| Rate for Payer: EPIC Health Plan Senior |
$199.02
|
| Rate for Payer: Galaxy Health WC |
$422.93
|
| Rate for Payer: Global Benefits Group Commercial |
$298.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$447.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$315.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$293.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$373.17
|
| Rate for Payer: Networks By Design Commercial |
$323.41
|
| Rate for Payer: Prime Health Services Commercial |
$422.93
|
|
|
HC SOM 28 ADD FISH PROBES
|
Facility
|
OP
|
$497.56
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914711
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,715.87 |
| Rate for Payer: Adventist Health Commercial |
$99.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,715.87
|
| Rate for Payer: Blue Shield of California Commercial |
$313.46
|
| Rate for Payer: Blue Shield of California EPN |
$197.53
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Cash Price |
$497.56
|
| Rate for Payer: Central Health Plan Commercial |
$398.05
|
| Rate for Payer: Cigna of CA HMO |
$318.44
|
| Rate for Payer: Cigna of CA PPO |
$368.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$348.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$422.93
|
| Rate for Payer: Global Benefits Group Commercial |
$298.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$447.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$315.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$373.17
|
| Rate for Payer: Networks By Design Commercial |
$323.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$422.93
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$298.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$298.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM 5-FLUOROCYTOSINE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC SOM 5-FLUOROCYTOSINE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911263
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$25.83
|
| Rate for Payer: Blue Shield of California EPN |
$16.28
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM 7-DEHYDROCHOLESTERL
|
Facility
|
OP
|
$84.56
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$16.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| 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 |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$53.27
|
| Rate for Payer: Blue Shield of California EPN |
$33.57
|
| Rate for Payer: Cash Price |
$84.56
|
| Rate for Payer: Cash Price |
$84.56
|
| Rate for Payer: Central Health Plan Commercial |
$67.65
|
| Rate for Payer: Cigna of CA HMO |
$54.12
|
| Rate for Payer: Cigna of CA PPO |
$62.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$71.88
|
| Rate for Payer: Global Benefits Group Commercial |
$50.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.10
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$63.42
|
| Rate for Payer: Networks By Design Commercial |
$54.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$71.88
|
| 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 |
$50.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.74
|
| 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 SOM 7-DEHYDROCHOLESTERL
|
Facility
|
IP
|
$84.56
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$76.10 |
| Rate for Payer: Adventist Health Commercial |
$16.91
|
| Rate for Payer: Cash Price |
$84.56
|
| Rate for Payer: Central Health Plan Commercial |
$67.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.82
|
| Rate for Payer: EPIC Health Plan Senior |
$33.82
|
| Rate for Payer: Galaxy Health WC |
$71.88
|
| Rate for Payer: Global Benefits Group Commercial |
$50.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$63.42
|
| Rate for Payer: Networks By Design Commercial |
$54.96
|
| Rate for Payer: Prime Health Services Commercial |
$71.88
|
|
|
HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY
|
Facility
|
OP
|
$26.81
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900912802
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$181.12 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.12
|
| Rate for Payer: Blue Shield of California Commercial |
$16.89
|
| Rate for Payer: Blue Shield of California EPN |
$10.64
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Central Health Plan Commercial |
$21.45
|
| Rate for Payer: Cigna of CA HMO |
$17.16
|
| Rate for Payer: Cigna of CA PPO |
$19.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.54
|
| Rate for Payer: EPIC Health Plan Senior |
$19.69
|
| Rate for Payer: Galaxy Health WC |
$22.79
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$20.11
|
| Rate for Payer: Networks By Design Commercial |
$17.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.79
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM 8INHE FACTOR VIII ACTIVITY ASSAY
|
Facility
|
IP
|
$26.81
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900912802
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Adventist Health Commercial |
$5.36
|
| Rate for Payer: Cash Price |
$26.81
|
| Rate for Payer: Central Health Plan Commercial |
$21.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.72
|
| Rate for Payer: EPIC Health Plan Senior |
$10.72
|
| Rate for Payer: Galaxy Health WC |
$22.79
|
| Rate for Payer: Global Benefits Group Commercial |
$16.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$20.11
|
| Rate for Payer: Networks By Design Commercial |
$17.43
|
| Rate for Payer: Prime Health Services Commercial |
$22.79
|
|
|
HC SOM 8INHE FACTOR VIII INHIB TECH INTERP
|
Facility
|
IP
|
$23.19
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900911120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Central Health Plan Commercial |
$18.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.28
|
| Rate for Payer: EPIC Health Plan Senior |
$9.28
|
| Rate for Payer: Galaxy Health WC |
$19.71
|
| Rate for Payer: Global Benefits Group Commercial |
$13.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Multiplan Commercial |
$17.39
|
| Rate for Payer: Networks By Design Commercial |
$15.07
|
| Rate for Payer: Prime Health Services Commercial |
$19.71
|
|
|
HC SOM 8INHE FACTOR VIII INHIB TECH INTERP
|
Facility
|
OP
|
$23.19
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900911120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$52.16 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.16
|
| Rate for Payer: Blue Shield of California Commercial |
$14.61
|
| Rate for Payer: Blue Shield of California EPN |
$9.21
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Central Health Plan Commercial |
$18.55
|
| Rate for Payer: Cigna of CA HMO |
$14.84
|
| Rate for Payer: Cigna of CA PPO |
$17.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$19.71
|
| Rate for Payer: Global Benefits Group Commercial |
$13.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$17.39
|
| Rate for Payer: Networks By Design Commercial |
$15.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$19.71
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
IP
|
$35.72
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$32.15 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Central Health Plan Commercial |
$28.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.29
|
| Rate for Payer: EPIC Health Plan Senior |
$14.29
|
| Rate for Payer: Galaxy Health WC |
$30.36
|
| Rate for Payer: Global Benefits Group Commercial |
$21.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$26.79
|
| Rate for Payer: Networks By Design Commercial |
$23.22
|
| Rate for Payer: Prime Health Services Commercial |
$30.36
|
|
|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
OP
|
$35.72
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$192.56 |
| Rate for Payer: Adventist Health Commercial |
$7.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.56
|
| Rate for Payer: Blue Shield of California Commercial |
$22.50
|
| Rate for Payer: Blue Shield of California EPN |
$14.18
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Central Health Plan Commercial |
$28.58
|
| Rate for Payer: Cigna of CA HMO |
$22.86
|
| Rate for Payer: Cigna of CA PPO |
$26.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.42
|
| Rate for Payer: EPIC Health Plan Senior |
$20.94
|
| Rate for Payer: Galaxy Health WC |
$30.36
|
| Rate for Payer: Global Benefits Group Commercial |
$21.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$26.79
|
| Rate for Payer: Networks By Design Commercial |
$23.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.04
|
| Rate for Payer: Prime Health Services Commercial |
$30.36
|
| Rate for Payer: Prime Health Services Medicare |
$20.18
|
| Rate for Payer: Riverside University Health System MISP |
$20.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
IP
|
$29.04
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$26.14 |
| Rate for Payer: Adventist Health Commercial |
$5.81
|
| Rate for Payer: Cash Price |
$29.04
|
| Rate for Payer: Central Health Plan Commercial |
$23.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.62
|
| Rate for Payer: EPIC Health Plan Senior |
$11.62
|
| Rate for Payer: Galaxy Health WC |
$24.68
|
| Rate for Payer: Global Benefits Group Commercial |
$17.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Multiplan Commercial |
$21.78
|
| Rate for Payer: Networks By Design Commercial |
$18.88
|
| Rate for Payer: Prime Health Services Commercial |
$24.68
|
|
