|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
|
IP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$73.28 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Central Health Plan Commercial |
$65.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.57
|
| Rate for Payer: EPIC Health Plan Senior |
$32.57
|
| Rate for Payer: Galaxy Health WC |
$69.21
|
| Rate for Payer: Global Benefits Group Commercial |
$48.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.28
|
| Rate for Payer: Multiplan Commercial |
$61.06
|
| Rate for Payer: Networks By Design Commercial |
$52.92
|
| Rate for Payer: Prime Health Services Commercial |
$69.21
|
|
|
HC SOM CAH DEOXYCORTICOSTERONE
|
Facility
|
OP
|
$81.42
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900912773
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$303.14 |
| Rate for Payer: Adventist Health Commercial |
$16.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.14
|
| Rate for Payer: Blue Shield of California Commercial |
$51.29
|
| Rate for Payer: Blue Shield of California EPN |
$32.32
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Cash Price |
$81.42
|
| Rate for Payer: Central Health Plan Commercial |
$65.14
|
| Rate for Payer: Cigna of CA HMO |
$52.11
|
| Rate for Payer: Cigna of CA PPO |
$60.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.12
|
| Rate for Payer: EPIC Health Plan Senior |
$34.08
|
| Rate for Payer: Galaxy Health WC |
$69.21
|
| Rate for Payer: Global Benefits Group Commercial |
$48.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$61.06
|
| Rate for Payer: Networks By Design Commercial |
$52.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.98
|
| Rate for Payer: Prime Health Services Commercial |
$69.21
|
| Rate for Payer: Prime Health Services Medicare |
$32.84
|
| Rate for Payer: Riverside University Health System MISP |
$34.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
|
IP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Central Health Plan Commercial |
$43.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.93
|
| Rate for Payer: Galaxy Health WC |
$46.61
|
| Rate for Payer: Global Benefits Group Commercial |
$32.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.97
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
| Rate for Payer: Networks By Design Commercial |
$35.64
|
| Rate for Payer: Prime Health Services Commercial |
$46.61
|
|
|
HC SOM CAH PROGESTERONE
|
Facility
|
OP
|
$54.83
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$211.01 |
| Rate for Payer: Adventist Health Commercial |
$10.97
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.01
|
| Rate for Payer: Blue Shield of California Commercial |
$34.54
|
| Rate for Payer: Blue Shield of California EPN |
$21.77
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Cash Price |
$54.83
|
| Rate for Payer: Central Health Plan Commercial |
$43.86
|
| Rate for Payer: Cigna of CA HMO |
$35.09
|
| Rate for Payer: Cigna of CA PPO |
$40.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.42
|
| Rate for Payer: EPIC Health Plan Senior |
$22.95
|
| Rate for Payer: Galaxy Health WC |
$46.61
|
| Rate for Payer: Global Benefits Group Commercial |
$32.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$41.12
|
| Rate for Payer: Networks By Design Commercial |
$35.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.86
|
| Rate for Payer: Prime Health Services Commercial |
$46.61
|
| Rate for Payer: Prime Health Services Medicare |
$22.11
|
| Rate for Payer: Riverside University Health System MISP |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other HMO |
$16.89
|
| Rate for Payer: United Healthcare HMO Rider |
$16.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
IP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Central Health Plan Commercial |
$54.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.13
|
| Rate for Payer: EPIC Health Plan Senior |
$27.13
|
| Rate for Payer: Galaxy Health WC |
$57.66
|
| Rate for Payer: Global Benefits Group Commercial |
$40.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
| Rate for Payer: Networks By Design Commercial |
$44.09
|
| Rate for Payer: Prime Health Services Commercial |
$57.66
|
|
|
HC SOM CAH TESTOSTERONE
|
Facility
|
OP
|
$67.83
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912779
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$261.06 |
| Rate for Payer: Adventist Health Commercial |
$13.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.06
|
| Rate for Payer: Blue Shield of California Commercial |
$42.73
|
| Rate for Payer: Blue Shield of California EPN |
$26.93
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Central Health Plan Commercial |
$54.26
|
| Rate for Payer: Cigna of CA HMO |
$43.41
|
| Rate for Payer: Cigna of CA PPO |
$50.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.59
|
| Rate for Payer: EPIC Health Plan Senior |
$28.39
|
| Rate for Payer: Galaxy Health WC |
$57.66
|
| Rate for Payer: Global Benefits Group Commercial |
$40.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$50.87
|
| Rate for Payer: Networks By Design Commercial |
$44.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.81
|
| Rate for Payer: Prime Health Services Commercial |
$57.66
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Riverside University Health System MISP |
$28.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM CALCITONIN
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$270.86 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.86
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: EPIC Health Plan Senior |
$29.47
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.90
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.79
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$28.40
|
| Rate for Payer: Riverside University Health System MISP |
$29.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.70
|
| Rate for Payer: United Healthcare All Other HMO |
$21.70
|
| Rate for Payer: United Healthcare HMO Rider |
$21.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.47
|
| Rate for Payer: Vantage Medical Group Senior |
$26.79
|
|
|
HC SOM CALCITONIN
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
900911003
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM CALPROTECTIN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$198.48 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.48
|
| Rate for Payer: Blue Shield of California Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California EPN |
$23.82
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.39
|
| Rate for Payer: EPIC Health Plan Senior |
$21.59
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.30
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.63
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Prime Health Services Medicare |
$20.81
|
| Rate for Payer: Riverside University Health System MISP |
$21.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.90
|
| Rate for Payer: United Healthcare All Other HMO |
$15.90
|
| Rate for Payer: United Healthcare HMO Rider |
$15.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.59
|
| Rate for Payer: Vantage Medical Group Senior |
$19.63
|
|
|
HC SOM CALPROTECTIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 83993
|
| Hospital Charge Code |
900912938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM CANDIDA AURIS SURV PCR
|
Facility
|
IP
|
$200.39
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900915483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.08 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Adventist Health Commercial |
$40.08
|
| Rate for Payer: Cash Price |
$200.39
|
| Rate for Payer: Central Health Plan Commercial |
$160.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.16
|
| Rate for Payer: EPIC Health Plan Senior |
$80.16
|
| Rate for Payer: Galaxy Health WC |
$170.33
|
| Rate for Payer: Global Benefits Group Commercial |
$120.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Multiplan Commercial |
$150.29
|
| Rate for Payer: Networks By Design Commercial |
$130.25
|
| Rate for Payer: Prime Health Services Commercial |
$170.33
|
|
|
HC SOM CANDIDA AURIS SURV PCR
|
Facility
|
OP
|
$200.39
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
900915483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$40.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$126.25
|
| Rate for Payer: Blue Shield of California EPN |
$79.55
|
| Rate for Payer: Cash Price |
$200.39
|
| Rate for Payer: Cash Price |
$200.39
|
| Rate for Payer: Central Health Plan Commercial |
$160.31
|
| Rate for Payer: Cigna of CA HMO |
$128.25
|
| Rate for Payer: Cigna of CA PPO |
$148.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$170.33
|
| Rate for Payer: Global Benefits Group Commercial |
$120.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.35
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$150.29
|
| Rate for Payer: Networks By Design Commercial |
$130.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$170.33
|
| 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 |
$120.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$148.23 |
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.14
|
| Rate for Payer: Blue Shield of California Commercial |
$103.76
|
| Rate for Payer: Blue Shield of California EPN |
$65.39
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$131.76
|
| Rate for Payer: Cigna of CA HMO |
$105.41
|
| Rate for Payer: Cigna of CA PPO |
$121.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$98.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$123.53
|
| Rate for Payer: Networks By Design Commercial |
$107.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.75
|
| Rate for Payer: Prime Health Services Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SOM CARBAPEN MOD HODGE TEST
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
CPT 87185
|
| Hospital Charge Code |
900914208
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$148.23 |
| Rate for Payer: Adventist Health Commercial |
$32.94
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$131.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.88
|
| Rate for Payer: EPIC Health Plan Senior |
$65.88
|
| Rate for Payer: Galaxy Health WC |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$98.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.94
|
| Rate for Payer: Multiplan Commercial |
$123.53
|
| Rate for Payer: Networks By Design Commercial |
$107.06
|
| Rate for Payer: Prime Health Services Commercial |
$140.00
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
IP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$44.94 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Central Health Plan Commercial |
$39.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.97
|
| Rate for Payer: EPIC Health Plan Senior |
$19.97
|
| Rate for Payer: Galaxy Health WC |
$42.44
|
| Rate for Payer: Global Benefits Group Commercial |
$29.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
| Rate for Payer: Networks By Design Commercial |
$32.45
|
| Rate for Payer: Prime Health Services Commercial |
$42.44
|
|
|
HC SOM CARB DEF TRANS CONGENITAL
|
Facility
|
OP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912514
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$132.53 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.79
|
| Rate for Payer: Blue Shield of California Commercial |
$31.46
|
| Rate for Payer: Blue Shield of California EPN |
$19.82
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Central Health Plan Commercial |
$39.94
|
| Rate for Payer: Cigna of CA HMO |
$31.96
|
| Rate for Payer: Cigna of CA PPO |
$36.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.87
|
| Rate for Payer: Galaxy Health WC |
$42.44
|
| Rate for Payer: Global Benefits Group Commercial |
$29.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
| Rate for Payer: Networks By Design Commercial |
$32.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.06
|
| Rate for Payer: Prime Health Services Commercial |
$42.44
|
| Rate for Payer: Prime Health Services Medicare |
$19.14
|
| Rate for Payer: Riverside University Health System MISP |
$19.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
OP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$132.53 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.79
|
| Rate for Payer: Blue Shield of California Commercial |
$31.46
|
| Rate for Payer: Blue Shield of California EPN |
$19.82
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Central Health Plan Commercial |
$39.94
|
| Rate for Payer: Cigna of CA HMO |
$31.96
|
| Rate for Payer: Cigna of CA PPO |
$36.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.87
|
| Rate for Payer: Galaxy Health WC |
$42.44
|
| Rate for Payer: Global Benefits Group Commercial |
$29.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
| Rate for Payer: Networks By Design Commercial |
$32.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.06
|
| Rate for Payer: Prime Health Services Commercial |
$42.44
|
| Rate for Payer: Prime Health Services Medicare |
$19.14
|
| Rate for Payer: Riverside University Health System MISP |
$19.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.87
|
| Rate for Payer: Vantage Medical Group Senior |
$18.06
|
|
|
HC SOM CARB DEF TRANSFERRIN ADULT
|
Facility
|
IP
|
$49.93
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
900912717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$44.94 |
| Rate for Payer: Adventist Health Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$49.93
|
| Rate for Payer: Central Health Plan Commercial |
$39.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.97
|
| Rate for Payer: EPIC Health Plan Senior |
$19.97
|
| Rate for Payer: Galaxy Health WC |
$42.44
|
| Rate for Payer: Global Benefits Group Commercial |
$29.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.99
|
| Rate for Payer: Multiplan Commercial |
$37.45
|
| Rate for Payer: Networks By Design Commercial |
$32.45
|
| Rate for Payer: Prime Health Services Commercial |
$42.44
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
900911041
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$124.67 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.67
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.33
|
| Rate for Payer: EPIC Health Plan Senior |
$13.55
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.32
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$13.06
|
| Rate for Payer: Riverside University Health System MISP |
$13.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Other HMO |
$9.98
|
| Rate for Payer: United Healthcare HMO Rider |
$9.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.55
|
| Rate for Payer: Vantage Medical Group Senior |
$12.32
|
|
|
HC SOM CARBOXY-THC CONFIRMATION, U
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900915422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM CARBOXY-THC CONFIRMATION, U
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900915422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$229.80 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.80
|
| Rate for Payer: Blue Shield of California Commercial |
$22.05
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Riverside University Health System MISP |
$14.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC SOM CARNITINE PLASMA
|
Facility
|
IP
|
$29.01
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.11 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Central Health Plan Commercial |
$23.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Senior |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.66
|
| Rate for Payer: Global Benefits Group Commercial |
$17.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.76
|
| Rate for Payer: Networks By Design Commercial |
$18.86
|
| Rate for Payer: Prime Health Services Commercial |
$24.66
|
|
|
HC SOM CARNITINE PLASMA
|
Facility
|
OP
|
$29.01
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900911103
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$169.82 |
| Rate for Payer: Adventist Health Commercial |
$5.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.82
|
| Rate for Payer: Blue Shield of California Commercial |
$18.28
|
| Rate for Payer: Blue Shield of California EPN |
$11.52
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Cash Price |
$29.01
|
| Rate for Payer: Central Health Plan Commercial |
$23.21
|
| Rate for Payer: Cigna of CA HMO |
$18.57
|
| Rate for Payer: Cigna of CA PPO |
$21.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$24.66
|
| Rate for Payer: Global Benefits Group Commercial |
$17.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$21.76
|
| Rate for Payer: Networks By Design Commercial |
$18.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$24.66
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM CARNITINE URINE
|
Facility
|
OP
|
$60.59
|
|
|
Service Code
|
CPT 82379
|
| Hospital Charge Code |
900910730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$169.82 |
| Rate for Payer: Adventist Health Commercial |
$12.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.82
|
| Rate for Payer: Blue Shield of California Commercial |
$38.17
|
| Rate for Payer: Blue Shield of California EPN |
$24.05
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Central Health Plan Commercial |
$48.47
|
| Rate for Payer: Cigna of CA HMO |
$38.78
|
| Rate for Payer: Cigna of CA PPO |
$44.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$51.50
|
| Rate for Payer: Global Benefits Group Commercial |
$36.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$45.44
|
| Rate for Payer: Networks By Design Commercial |
$39.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$51.50
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
