|
HC SOM IA2 AB
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900914354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM IGA SUBCLASSES IGA 1
|
Facility
|
OP
|
$31.19
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$336.91 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.91
|
| Rate for Payer: Blue Shield of California Commercial |
$19.65
|
| Rate for Payer: Blue Shield of California EPN |
$12.38
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Central Health Plan Commercial |
$24.95
|
| Rate for Payer: Cigna of CA HMO |
$19.96
|
| Rate for Payer: Cigna of CA PPO |
$23.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$26.51
|
| Rate for Payer: Global Benefits Group Commercial |
$18.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Networks By Design Commercial |
$20.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.02
|
| Rate for Payer: Prime Health Services Commercial |
$26.51
|
| Rate for Payer: Prime Health Services Medicare |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC SOM IGA SUBCLASSES IGA 1
|
Facility
|
IP
|
$31.19
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$28.07 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Central Health Plan Commercial |
$24.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Senior |
$12.48
|
| Rate for Payer: Galaxy Health WC |
$26.51
|
| Rate for Payer: Global Benefits Group Commercial |
$18.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Networks By Design Commercial |
$20.27
|
| Rate for Payer: Prime Health Services Commercial |
$26.51
|
|
|
HC SOM IGA SUBCLASSES IGA 2
|
Facility
|
OP
|
$31.19
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$336.91 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.91
|
| Rate for Payer: Blue Shield of California Commercial |
$19.65
|
| Rate for Payer: Blue Shield of California EPN |
$12.38
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Central Health Plan Commercial |
$24.95
|
| Rate for Payer: Cigna of CA HMO |
$19.96
|
| Rate for Payer: Cigna of CA PPO |
$23.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$26.51
|
| Rate for Payer: Global Benefits Group Commercial |
$18.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Networks By Design Commercial |
$20.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.02
|
| Rate for Payer: Prime Health Services Commercial |
$26.51
|
| Rate for Payer: Prime Health Services Medicare |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC SOM IGA SUBCLASSES IGA 2
|
Facility
|
IP
|
$31.19
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900912704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$28.07 |
| Rate for Payer: Adventist Health Commercial |
$6.24
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Central Health Plan Commercial |
$24.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.48
|
| Rate for Payer: EPIC Health Plan Senior |
$12.48
|
| Rate for Payer: Galaxy Health WC |
$26.51
|
| Rate for Payer: Global Benefits Group Commercial |
$18.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$23.39
|
| Rate for Payer: Networks By Design Commercial |
$20.27
|
| Rate for Payer: Prime Health Services Commercial |
$26.51
|
|
|
HC SOM IGA SUBCLASSES TOTAL IGA
|
Facility
|
IP
|
$36.17
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900912705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Central Health Plan Commercial |
$28.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.47
|
| Rate for Payer: EPIC Health Plan Senior |
$14.47
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Multiplan Commercial |
$27.13
|
| Rate for Payer: Networks By Design Commercial |
$23.51
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
|
|
HC SOM IGA SUBCLASSES TOTAL IGA
|
Facility
|
OP
|
$36.17
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900912705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$78.37 |
| Rate for Payer: Adventist Health Commercial |
$7.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.37
|
| Rate for Payer: Blue Shield of California Commercial |
$22.79
|
| Rate for Payer: Blue Shield of California EPN |
$14.36
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Central Health Plan Commercial |
$28.94
|
| Rate for Payer: Cigna of CA HMO |
$23.15
|
| Rate for Payer: Cigna of CA PPO |
$26.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$30.74
|
| Rate for Payer: Global Benefits Group Commercial |
$21.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$27.13
|
| Rate for Payer: Networks By Design Commercial |
$23.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$30.74
|
| Rate for Payer: Prime Health Services Medicare |
$9.86
|
| Rate for Payer: Riverside University Health System MISP |
$10.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM IGF-BP3
|
Facility
|
OP
|
$17.27
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$10.88
|
| Rate for Payer: Blue Shield of California EPN |
$6.86
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Central Health Plan Commercial |
$13.82
|
| Rate for Payer: Cigna of CA HMO |
$11.05
|
| Rate for Payer: Cigna of CA PPO |
$12.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$14.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
| Rate for Payer: Networks By Design Commercial |
$11.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$14.68
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM IGF-BP3
|
Facility
|
IP
|
$17.27
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900911428
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Adventist Health Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Central Health Plan Commercial |
$13.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$6.91
|
| Rate for Payer: Galaxy Health WC |
$14.68
|
| Rate for Payer: Global Benefits Group Commercial |
$10.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.45
|
| Rate for Payer: Multiplan Commercial |
$12.95
|
| Rate for Payer: Networks By Design Commercial |
$11.23
|
| Rate for Payer: Prime Health Services Commercial |
$14.68
|
|
|
HC SOM IGG FRAC. TOTAL IGG
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900912808
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
HC SOM IGG FRAC. TOTAL IGG
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900912808
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$78.37 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Medicare |
$9.86
|
| Rate for Payer: Riverside University Health System MISP |
$10.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM IGG SYNTHESIS INDEX-CSF
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900911436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
|
|
HC SOM IGG SYNTHESIS INDEX-CSF
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900911436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$78.37 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.37
|
| Rate for Payer: Blue Shield of California Commercial |
$6.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: Cigna of CA HMO |
$6.62
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Prime Health Services Medicare |
$9.86
|
| Rate for Payer: Riverside University Health System MISP |
$10.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM IL 28 B POLYMORPHISM GENOT
|
Facility
|
IP
|
$312.70
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
900912991
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$62.54 |
| Max. Negotiated Rate |
$281.43 |
| Rate for Payer: Adventist Health Commercial |
$62.54
|
| Rate for Payer: Cash Price |
$312.70
|
| Rate for Payer: Central Health Plan Commercial |
$250.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.08
|
| Rate for Payer: EPIC Health Plan Senior |
$125.08
|
| Rate for Payer: Galaxy Health WC |
$265.80
|
| Rate for Payer: Global Benefits Group Commercial |
$187.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.54
|
| Rate for Payer: Multiplan Commercial |
$234.53
|
| Rate for Payer: Networks By Design Commercial |
$203.25
|
| Rate for Payer: Prime Health Services Commercial |
$265.80
|
|
|
HC SOM IL 28 B POLYMORPHISM GENOT
|
Facility
|
OP
|
$312.70
|
|
|
Service Code
|
CPT 81400
|
| Hospital Charge Code |
900912991
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$320.02 |
| Rate for Payer: Adventist Health Commercial |
$62.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$63.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$320.02
|
| Rate for Payer: Blue Shield of California Commercial |
$197.00
|
| Rate for Payer: Blue Shield of California EPN |
$124.14
|
| Rate for Payer: Cash Price |
$312.70
|
| Rate for Payer: Cash Price |
$312.70
|
| Rate for Payer: Central Health Plan Commercial |
$250.16
|
| Rate for Payer: Cigna of CA HMO |
$200.13
|
| Rate for Payer: Cigna of CA PPO |
$231.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.53
|
| Rate for Payer: EPIC Health Plan Senior |
$70.36
|
| Rate for Payer: Galaxy Health WC |
$265.80
|
| Rate for Payer: Global Benefits Group Commercial |
$187.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$281.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$104.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$85.71
|
| Rate for Payer: Multiplan Commercial |
$234.53
|
| Rate for Payer: Networks By Design Commercial |
$203.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$63.96
|
| Rate for Payer: Prime Health Services Commercial |
$265.80
|
| Rate for Payer: Prime Health Services Medicare |
$67.80
|
| Rate for Payer: Riverside University Health System MISP |
$70.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.80
|
| Rate for Payer: United Healthcare All Other HMO |
$51.80
|
| Rate for Payer: United Healthcare HMO Rider |
$51.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$63.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.36
|
| Rate for Payer: Vantage Medical Group Senior |
$63.96
|
|
|
HC SOM IL-6
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913874
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$47.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM IL-6
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913874
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM IMMUNOGLOBULIN IGD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM IMMUNOGLOBULIN IGD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900910574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$78.37 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.37
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.35
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.30
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$9.86
|
| Rate for Payer: Riverside University Health System MISP |
$10.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM IMMUNOGLOBULINS,IGC SUBCLASS 1
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
HC SOM IMMUNOGLOBULINS,IGC SUBCLASS 1
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911271
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$336.91 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Medicare |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2.40
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
|
|
HC SOM IMMUNOGLOBULINS,IGG SUBCLASS 2
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$336.91 |
| Rate for Payer: Adventist Health Commercial |
$1.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.91
|
| Rate for Payer: Blue Shield of California Commercial |
$3.78
|
| Rate for Payer: Blue Shield of California EPN |
$2.38
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Central Health Plan Commercial |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$3.84
|
| Rate for Payer: Cigna of CA PPO |
$4.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$5.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$4.50
|
| Rate for Payer: Networks By Design Commercial |
$3.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.10
|
| Rate for Payer: Prime Health Services Medicare |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3
|
Facility
|
IP
|
$7.24
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.52 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.90
|
| Rate for Payer: EPIC Health Plan Senior |
$2.90
|
| Rate for Payer: Galaxy Health WC |
$6.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$5.43
|
| Rate for Payer: Networks By Design Commercial |
$4.71
|
| Rate for Payer: Prime Health Services Commercial |
$6.15
|
|
|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 3
|
Facility
|
OP
|
$7.24
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900911273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$336.91 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.87
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Cash Price |
$7.24
|
| Rate for Payer: Central Health Plan Commercial |
$5.79
|
| Rate for Payer: Cigna of CA HMO |
$4.63
|
| Rate for Payer: Cigna of CA PPO |
$5.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$6.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$5.43
|
| Rate for Payer: Networks By Design Commercial |
$4.71
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.02
|
| Rate for Payer: Prime Health Services Commercial |
$6.15
|
| Rate for Payer: Prime Health Services Medicare |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
