|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| 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 HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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 NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM NEUROTENSIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC SOM NEUROTENSIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$180.63
|
| Rate for Payer: Blue Shield of California EPN |
$119.34
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$130.46
|
| Rate for Payer: Blue Shield of California EPN |
$86.19
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
IP
|
$194.68
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.94 |
| Max. Negotiated Rate |
$165.48 |
| Rate for Payer: Adventist Health Commercial |
$38.94
|
| Rate for Payer: Cash Price |
$194.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.87
|
| Rate for Payer: EPIC Health Plan Senior |
$77.87
|
| Rate for Payer: Galaxy Health WC |
$165.48
|
| Rate for Payer: Global Benefits Group Commercial |
$116.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.72
|
| Rate for Payer: Multiplan Commercial |
$155.74
|
| Rate for Payer: Networks By Design Commercial |
$126.54
|
| Rate for Payer: Prime Health Services Commercial |
$165.48
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
OP
|
$194.68
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$38.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.69
|
| 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 |
$130.24
|
| Rate for Payer: Blue Shield of California EPN |
$86.05
|
| Rate for Payer: Cash Price |
$194.68
|
| Rate for Payer: Cash Price |
$194.68
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$144.06
|
| 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 |
$165.48
|
| Rate for Payer: Global Benefits Group Commercial |
$116.81
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.72
|
| 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 |
$155.74
|
| Rate for Payer: Networks By Design Commercial |
$126.54
|
| Rate for Payer: Prime Health Services Commercial |
$165.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.81
|
| 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 NICOTINE
|
Facility
|
IP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$8.14
|
| Rate for Payer: Galaxy Health WC |
$17.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.30
|
|
|
HC SOM NICOTINE
|
Facility
|
OP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$284.41 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.41
|
| Rate for Payer: Blue Shield of California Commercial |
$13.61
|
| Rate for Payer: Blue Shield of California EPN |
$8.99
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cigna of CA HMO |
$13.02
|
| Rate for Payer: Cigna of CA PPO |
$15.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$8.14
|
| Rate for Payer: Galaxy Health WC |
$17.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO |
$10.18
|
| Rate for Payer: United Healthcare HMO Rider |
$10.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.30
|
| Rate for Payer: Vantage Medical Group Senior |
$17.30
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
IP
|
$422.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$359.04 |
| Rate for Payer: Adventist Health Commercial |
$84.48
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.96
|
| Rate for Payer: EPIC Health Plan Senior |
$168.96
|
| Rate for Payer: Galaxy Health WC |
$359.04
|
| Rate for Payer: Global Benefits Group Commercial |
$253.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.38
|
| Rate for Payer: Multiplan Commercial |
$337.92
|
| Rate for Payer: Networks By Design Commercial |
$274.56
|
| Rate for Payer: Prime Health Services Commercial |
$359.04
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
OP
|
$422.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$359.04 |
| Rate for Payer: Adventist Health Commercial |
$84.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$316.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.40
|
| Rate for Payer: Blue Shield of California Commercial |
$282.59
|
| Rate for Payer: Blue Shield of California EPN |
$186.70
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna of CA HMO |
$270.34
|
| Rate for Payer: Cigna of CA PPO |
$312.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.96
|
| Rate for Payer: EPIC Health Plan Senior |
$168.96
|
| Rate for Payer: Galaxy Health WC |
$359.04
|
| Rate for Payer: Global Benefits Group Commercial |
$253.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$281.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$261.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$295.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$295.68
|
| Rate for Payer: Multiplan Commercial |
$337.92
|
| Rate for Payer: Networks By Design Commercial |
$274.56
|
| Rate for Payer: Prime Health Services Commercial |
$359.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Other HMO |
$211.20
|
| Rate for Payer: United Healthcare HMO Rider |
$211.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.04
|
| Rate for Payer: Vantage Medical Group Senior |
$359.04
|
|
|
HC SOM NMDCS 86255
|
Facility
|
IP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$292.68 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.73
|
| Rate for Payer: EPIC Health Plan Senior |
$137.73
|
| Rate for Payer: Galaxy Health WC |
$292.68
|
| Rate for Payer: Global Benefits Group Commercial |
$206.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.64
|
| Rate for Payer: Multiplan Commercial |
$275.46
|
| Rate for Payer: Networks By Design Commercial |
$223.81
|
| Rate for Payer: Prime Health Services Commercial |
$292.68
|
|
|
HC SOM NMDCS 86255
|
Facility
|
OP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$292.68 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.85
|
| 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 |
$230.36
|
| Rate for Payer: Blue Shield of California EPN |
$152.19
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Cigna of CA HMO |
$220.37
|
| Rate for Payer: Cigna of CA PPO |
$254.80
|
| 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 |
$292.68
|
| Rate for Payer: Global Benefits Group Commercial |
$206.60
|
| 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 |
$229.67
|
| 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 |
$82.64
|
| 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 |
$275.46
|
| Rate for Payer: Networks By Design Commercial |
$223.81
|
| Rate for Payer: Prime Health Services Commercial |
$292.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.60
|
| 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 NMHIN 83789
|
Facility
|
IP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.08 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.98
|
| Rate for Payer: EPIC Health Plan Senior |
$64.98
|
| Rate for Payer: Galaxy Health WC |
$138.08
|
| Rate for Payer: Global Benefits Group Commercial |
$97.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$129.96
|
| Rate for Payer: Networks By Design Commercial |
$105.59
|
| Rate for Payer: Prime Health Services Commercial |
$138.08
|
|
|
HC SOM NMHIN 83789
|
Facility
|
OP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$108.68
|
| Rate for Payer: Blue Shield of California EPN |
$71.80
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cigna of CA HMO |
$103.97
|
| Rate for Payer: Cigna of CA PPO |
$120.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: EPIC Health Plan Senior |
$24.11
|
| Rate for Payer: Galaxy Health WC |
$138.08
|
| Rate for Payer: Global Benefits Group Commercial |
$97.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$129.96
|
| Rate for Payer: Networks By Design Commercial |
$105.59
|
| Rate for Payer: Prime Health Services Commercial |
$138.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM NMO/AQP4 FACS
|
Facility
|
OP
|
$227.49
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$193.37 |
| Rate for Payer: Adventist Health Commercial |
$45.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.51
|
| Rate for Payer: Blue Shield of California Commercial |
$152.19
|
| Rate for Payer: Blue Shield of California EPN |
$100.55
|
| Rate for Payer: Cash Price |
$227.49
|
| Rate for Payer: Cash Price |
$227.49
|
| Rate for Payer: Cigna of CA HMO |
$145.59
|
| Rate for Payer: Cigna of CA PPO |
$168.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$193.37
|
| Rate for Payer: Global Benefits Group Commercial |
$136.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$181.99
|
| Rate for Payer: Networks By Design Commercial |
$147.87
|
| Rate for Payer: Prime Health Services Commercial |
$193.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.49
|
| 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 |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM NMO/AQP4 FACS
|
Facility
|
IP
|
$227.49
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$193.37 |
| Rate for Payer: EPIC Health Plan Senior |
$91.00
|
| Rate for Payer: Galaxy Health WC |
$193.37
|
| Rate for Payer: Adventist Health Commercial |
$45.50
|
| Rate for Payer: Cash Price |
$227.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.00
|
| Rate for Payer: Global Benefits Group Commercial |
$136.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$181.99
|
| Rate for Payer: Networks By Design Commercial |
$147.87
|
| Rate for Payer: Prime Health Services Commercial |
$193.37
|
|
|
HC SOM NMO/AQP4 FACS TITER
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915464
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM NMO/AQP4 FACS TITER
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915464
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.51
|
| Rate for Payer: Blue Shield of California Commercial |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$33.15
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$123.77
|
| Rate for Payer: Blue Shield of California EPN |
$81.77
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.84
|
| Rate for Payer: Blue Shield of California Commercial |
$137.15
|
| Rate for Payer: Blue Shield of California EPN |
$90.61
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC SOMN NC08 CSF A-AMIN 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914733
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.84
|
| Rate for Payer: Blue Shield of California Commercial |
$137.15
|
| Rate for Payer: Blue Shield of California EPN |
$90.61
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
