|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4
|
Facility
|
IP
|
$7.25
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900910440
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: Adventist Health Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Central Health Plan Commercial |
$5.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.90
|
| Rate for Payer: EPIC Health Plan Senior |
$2.90
|
| Rate for Payer: Galaxy Health WC |
$6.16
|
| Rate for Payer: Global Benefits Group Commercial |
$4.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$5.44
|
| Rate for Payer: Networks By Design Commercial |
$4.71
|
| Rate for Payer: Prime Health Services Commercial |
$6.16
|
|
|
HC SOM IMMUNOGLOBULINS IGG SUBCLASS 4
|
Facility
|
OP
|
$7.25
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
900910440
|
|
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 |
$4.57
|
| Rate for Payer: Blue Shield of California EPN |
$2.88
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Cash Price |
$7.25
|
| Rate for Payer: Central Health Plan Commercial |
$5.80
|
| Rate for Payer: Cigna of CA HMO |
$4.64
|
| Rate for Payer: Cigna of CA PPO |
$5.37
|
| 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 |
$5.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$6.16
|
| Rate for Payer: Global Benefits Group Commercial |
$4.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.53
|
| 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 |
$5.44
|
| 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 |
$6.16
|
| 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 |
$4.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.35
|
| 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 INFLIXIMAB AB
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM INFLIXIMAB AB
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915313
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$142.92 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.92
|
| Rate for Payer: Blue Shield of California Commercial |
$63.00
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.53
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.12
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Riverside University Health System MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM INFLIXIMAB, QUANT
|
Facility
|
OP
|
$155.31
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
900915310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Adventist Health Commercial |
$31.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Blue Shield of California Commercial |
$97.85
|
| Rate for Payer: Blue Shield of California EPN |
$61.66
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Central Health Plan Commercial |
$124.25
|
| Rate for Payer: Cigna of CA HMO |
$99.40
|
| Rate for Payer: Cigna of CA PPO |
$114.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$132.01
|
| Rate for Payer: Global Benefits Group Commercial |
$93.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Networks By Design Commercial |
$100.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.57
|
| Rate for Payer: Prime Health Services Commercial |
$132.01
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Riverside University Health System MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM INFLIXIMAB, QUANT
|
Facility
|
IP
|
$155.31
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
900915310
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$139.78 |
| Rate for Payer: Adventist Health Commercial |
$31.06
|
| Rate for Payer: Cash Price |
$155.31
|
| Rate for Payer: Central Health Plan Commercial |
$124.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$108.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.12
|
| Rate for Payer: EPIC Health Plan Senior |
$62.12
|
| Rate for Payer: Galaxy Health WC |
$132.01
|
| Rate for Payer: Global Benefits Group Commercial |
$93.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$98.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$91.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Networks By Design Commercial |
$100.95
|
| Rate for Payer: Prime Health Services Commercial |
$132.01
|
|
|
HC SOM INFLUENZA A AB TITER (CF)
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$139.72 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.72
|
| Rate for Payer: Blue Shield of California Commercial |
$9.29
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: Cigna of CA HMO |
$9.44
|
| Rate for Payer: Cigna of CA PPO |
$10.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.36
|
| Rate for Payer: EPIC Health Plan Senior |
$14.90
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.55
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
| Rate for Payer: Prime Health Services Medicare |
$14.36
|
| Rate for Payer: Riverside University Health System MISP |
$14.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOM INFLUENZA A AB TITER (CF)
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
|
|
HC SOM INFLUENZA B AB TITER (CF)
|
Facility
|
OP
|
$7.50
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$139.72 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.72
|
| Rate for Payer: Blue Shield of California EPN |
$2.98
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.00
|
| Rate for Payer: Cigna of CA HMO |
$4.80
|
| Rate for Payer: Cigna of CA PPO |
$5.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.36
|
| Rate for Payer: EPIC Health Plan Senior |
$14.90
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.16
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.55
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
| Rate for Payer: Prime Health Services Medicare |
$14.36
|
| Rate for Payer: Riverside University Health System MISP |
$14.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.98
|
| Rate for Payer: United Healthcare All Other HMO |
$10.98
|
| Rate for Payer: United Healthcare HMO Rider |
$10.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.90
|
| Rate for Payer: Vantage Medical Group Senior |
$13.55
|
|
|
HC SOM INFLUENZA B AB TITER (CF)
|
Facility
|
IP
|
$7.50
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
900911772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$6.75 |
| Rate for Payer: Adventist Health Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Central Health Plan Commercial |
$6.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3.00
|
| Rate for Payer: Galaxy Health WC |
$6.38
|
| Rate for Payer: Global Benefits Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$5.62
|
| Rate for Payer: Networks By Design Commercial |
$4.88
|
| Rate for Payer: Prime Health Services Commercial |
$6.38
|
|
|
HC SOM INHIBIN B
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM INHIBIN B
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913934
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| 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 |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| 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 |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| 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 |
$31.75
|
| 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 |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| 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 |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| 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 INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM INSULIN ANTIBODIES QUANTITATIV
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
900911061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$183.84 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.84
|
| Rate for Payer: Blue Shield of California Commercial |
$40.95
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.33
|
| Rate for Payer: EPIC Health Plan Senior |
$23.55
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.69
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.41
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$22.69
|
| Rate for Payer: Riverside University Health System MISP |
$23.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.34
|
| Rate for Payer: United Healthcare All Other HMO |
$17.34
|
| Rate for Payer: United Healthcare HMO Rider |
$17.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.55
|
| Rate for Payer: Vantage Medical Group Senior |
$21.41
|
|
|
HC SOM INSULIN-LIKE GROWTH FACTOR I
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
900911132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25.00
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
|
|
HC SOM INSULIN-LIKE GROWTH FACTOR I
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
900911132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$172.00 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.00
|
| Rate for Payer: Blue Shield of California Commercial |
$39.38
|
| Rate for Payer: Blue Shield of California EPN |
$24.81
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$40.00
|
| Rate for Payer: Cigna of CA PPO |
$46.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.08
|
| Rate for Payer: EPIC Health Plan Senior |
$23.39
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.49
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.26
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
| Rate for Payer: Prime Health Services Medicare |
$22.54
|
| Rate for Payer: Riverside University Health System MISP |
$23.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.22
|
| Rate for Payer: United Healthcare All Other HMO |
$17.22
|
| Rate for Payer: United Healthcare HMO Rider |
$17.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.39
|
| Rate for Payer: Vantage Medical Group Senior |
$21.26
|
|
|
HC SOM INTERPHASES 100-300
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900915276
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$2,647.34 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,647.34
|
| Rate for Payer: Blue Shield of California Commercial |
$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 |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| 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 |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| 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 |
$51.19
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM INTERPHASES 100-300
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900915276
|
|
Hospital Revenue Code
|
310
|
| 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 INTERPHASES 25-99
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915275
|
|
Hospital Revenue Code
|
310
|
| 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 INTERPHASES 25-99
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915275
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$2,117.87 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,523.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,117.87
|
| 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 |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.93
|
| Rate for Payer: EPIC Health Plan Senior |
$46.62
|
| 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 |
$69.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.79
|
| 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 |
$42.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.92
|
| Rate for Payer: Riverside University Health System MISP |
$46.62
|
| 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 |
$34.33
|
| Rate for Payer: United Healthcare All Other HMO |
$34.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC SOM INTERPHASES LT 25
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915277
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$2,117.87 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$255.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,523.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,117.87
|
| 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 |
$63.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.93
|
| Rate for Payer: EPIC Health Plan Senior |
$46.62
|
| 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 |
$69.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.79
|
| 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 |
$42.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.92
|
| Rate for Payer: Riverside University Health System MISP |
$46.62
|
| 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 |
$34.33
|
| Rate for Payer: United Healthcare All Other HMO |
$34.33
|
| Rate for Payer: United Healthcare HMO Rider |
$34.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.62
|
| Rate for Payer: Vantage Medical Group Senior |
$42.38
|
|
|
HC SOM INTERPHASES LT 25
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88274
|
| Hospital Charge Code |
900915277
|
|
Hospital Revenue Code
|
310
|
| 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 INTRINSIC FACTOR BLOCKING AB
|
Facility
|
OP
|
$23.15
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
900911094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$152.45 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.45
|
| Rate for Payer: Blue Shield of California Commercial |
$14.58
|
| Rate for Payer: Blue Shield of California EPN |
$9.19
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Central Health Plan Commercial |
$18.52
|
| Rate for Payer: Cigna of CA HMO |
$14.82
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.88
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$19.68
|
| Rate for Payer: Global Benefits Group Commercial |
$13.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$15.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.08
|
| Rate for Payer: Prime Health Services Commercial |
$19.68
|
| Rate for Payer: Prime Health Services Medicare |
$15.98
|
| Rate for Payer: Riverside University Health System MISP |
$16.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM INTRINSIC FACTOR BLOCKING AB
|
Facility
|
IP
|
$23.15
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
900911094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Central Health Plan Commercial |
$18.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.26
|
| Rate for Payer: EPIC Health Plan Senior |
$9.26
|
| Rate for Payer: Galaxy Health WC |
$19.68
|
| Rate for Payer: Global Benefits Group Commercial |
$13.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$19.68
|
|
|
HC SOM IRON LIVER TISSUE
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
CPT 83540
|
| Hospital Charge Code |
900914805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$65.50 |
| Rate for Payer: Adventist Health Commercial |
$1.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5.85
|
| Rate for Payer: Blue Shield of California EPN |
$3.68
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$5.94
|
| Rate for Payer: Cigna of CA PPO |
$6.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$7.89
|
| Rate for Payer: Global Benefits Group Commercial |
$5.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$6.96
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$7.89
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
