|
HC SOM CHROMOSOMES SKIN BIOPSY
|
Facility
|
IP
|
$276.95
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912547
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$235.41 |
| Rate for Payer: Adventist Health Commercial |
$55.39
|
| Rate for Payer: Cash Price |
$276.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.78
|
| Rate for Payer: EPIC Health Plan Senior |
$110.78
|
| Rate for Payer: Galaxy Health WC |
$235.41
|
| Rate for Payer: Global Benefits Group Commercial |
$166.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.47
|
| Rate for Payer: Multiplan Commercial |
$221.56
|
| Rate for Payer: Networks By Design Commercial |
$180.02
|
| Rate for Payer: Prime Health Services Commercial |
$235.41
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$107.04
|
| Rate for Payer: Blue Shield of California EPN |
$70.72
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.82
|
| Rate for Payer: EPIC Health Plan Senior |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
OP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$1,179.99 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,179.99
|
| Rate for Payer: Blue Shield of California Commercial |
$115.76
|
| Rate for Payer: Blue Shield of California EPN |
$76.48
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: Cigna of CA HMO |
$110.75
|
| Rate for Payer: Cigna of CA PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Senior |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$138.43
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
|
IP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$147.08 |
| Rate for Payer: Adventist Health Commercial |
$34.61
|
| Rate for Payer: Cash Price |
$173.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.22
|
| Rate for Payer: EPIC Health Plan Senior |
$69.22
|
| Rate for Payer: Galaxy Health WC |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.53
|
| Rate for Payer: Multiplan Commercial |
$138.43
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$842.52 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$842.52
|
| Rate for Payer: Blue Shield of California Commercial |
$217.59
|
| Rate for Payer: Blue Shield of California EPN |
$143.76
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.55
|
| Rate for Payer: EPIC Health Plan Senior |
$250.78
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$411.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.05
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.13
|
| Rate for Payer: United Healthcare All Other HMO |
$203.13
|
| Rate for Payer: United Healthcare HMO Rider |
$203.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$250.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Vantage Medical Group Senior |
$250.78
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.06
|
| Rate for Payer: Blue Shield of California Commercial |
$217.59
|
| Rate for Payer: Blue Shield of California EPN |
$143.76
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.67
|
| Rate for Payer: Multiplan Commercial |
$260.19
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.62
|
| Rate for Payer: United Healthcare All Other HMO |
$162.62
|
| Rate for Payer: United Healthcare HMO Rider |
$162.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$276.45
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$274.57 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.57
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.53
|
| Rate for Payer: EPIC Health Plan Senior |
$27.80
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.80
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$175.22 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.22
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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 |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| 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 |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
IP
|
$31.59
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$26.85 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$26.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Multiplan Commercial |
$25.27
|
| Rate for Payer: Networks By Design Commercial |
$20.53
|
| Rate for Payer: Prime Health Services Commercial |
$26.85
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
OP
|
$31.59
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$109.92 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.92
|
| Rate for Payer: Blue Shield of California Commercial |
$21.13
|
| Rate for Payer: Blue Shield of California EPN |
$13.96
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Cigna of CA HMO |
$20.22
|
| Rate for Payer: Cigna of CA PPO |
$23.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$26.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$25.27
|
| Rate for Payer: Networks By Design Commercial |
$20.53
|
| Rate for Payer: Prime Health Services Commercial |
$26.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.33
|
| Rate for Payer: United Healthcare All Other HMO |
$16.33
|
| Rate for Payer: United Healthcare HMO Rider |
$16.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM CMVQU 87497
|
Facility
|
IP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$283.81 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.56
|
| Rate for Payer: EPIC Health Plan Senior |
$133.56
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.14
|
| Rate for Payer: Multiplan Commercial |
$267.12
|
| Rate for Payer: Networks By Design Commercial |
$217.03
|
| Rate for Payer: Prime Health Services Commercial |
$283.81
|
|
|
HC SOM CMVQU 87497
|
Facility
|
OP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$283.81 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$219.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$223.38
|
| Rate for Payer: Blue Shield of California EPN |
$147.58
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cigna of CA HMO |
$213.70
|
| Rate for Payer: Cigna of CA PPO |
$247.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$267.12
|
| Rate for Payer: Networks By Design Commercial |
$217.03
|
| Rate for Payer: Prime Health Services Commercial |
$283.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$200.70
|
| Rate for Payer: Blue Shield of California EPN |
$132.60
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.10
|
| Rate for Payer: Blue Shield of California Commercial |
$200.70
|
| Rate for Payer: Blue Shield of California EPN |
$132.60
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
OP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$176.88 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.88
|
| Rate for Payer: Blue Shield of California Commercial |
$50.39
|
| Rate for Payer: Blue Shield of California EPN |
$33.29
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cigna of CA HMO |
$48.20
|
| Rate for Payer: Cigna of CA PPO |
$55.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$60.26
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
IP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.13
|
| Rate for Payer: EPIC Health Plan Senior |
$30.13
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.08
|
| Rate for Payer: Multiplan Commercial |
$60.26
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
|
