|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
OP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$198.56 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.56
|
| Rate for Payer: Blue Shield of California Commercial |
$15.29
|
| Rate for Payer: Blue Shield of California EPN |
$10.10
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cigna of CA HMO |
$14.63
|
| Rate for Payer: Cigna of CA PPO |
$16.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.98
|
| Rate for Payer: EPIC Health Plan Senior |
$27.39
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.70
|
| Rate for Payer: Multiplan Commercial |
$18.29
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$19.43 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.14
|
| Rate for Payer: EPIC Health Plan Senior |
$9.14
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.49
|
| Rate for Payer: Multiplan Commercial |
$18.29
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$184.33 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.33
|
| Rate for Payer: Blue Shield of California Commercial |
$9.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.16
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Cigna of CA HMO |
$8.92
|
| Rate for Payer: Cigna of CA PPO |
$10.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6.96
|
| Rate for Payer: United Healthcare HMO Rider |
$6.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$11.84 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$11.14
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.85
|
| Rate for Payer: Blue Shield of California Commercial |
$26.76
|
| Rate for Payer: Blue Shield of California EPN |
$17.68
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.21
|
| Rate for Payer: EPIC Health Plan Senior |
$16.45
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.04
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.33
|
| Rate for Payer: United Healthcare All Other HMO |
$13.33
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Vantage Medical Group Senior |
$16.45
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
OP
|
$17.20
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$11.51
|
| Rate for Payer: Blue Shield of California EPN |
$7.60
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cigna of CA HMO |
$11.01
|
| Rate for Payer: Cigna of CA PPO |
$12.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$11.18
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
IP
|
$17.20
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.88
|
| Rate for Payer: EPIC Health Plan Senior |
$6.88
|
| Rate for Payer: Galaxy Health WC |
$14.62
|
| Rate for Payer: Global Benefits Group Commercial |
$10.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.76
|
| Rate for Payer: Networks By Design Commercial |
$11.18
|
| Rate for Payer: Prime Health Services Commercial |
$14.62
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
|
OP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.42
|
| Rate for Payer: Blue Shield of California Commercial |
$15.88
|
| Rate for Payer: Blue Shield of California EPN |
$10.49
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$17.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$20.18
|
| Rate for Payer: Global Benefits Group Commercial |
$14.24
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$18.99
|
| Rate for Payer: Networks By Design Commercial |
$15.43
|
| Rate for Payer: Prime Health Services Commercial |
$20.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
|
IP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$20.18 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.50
|
| Rate for Payer: EPIC Health Plan Senior |
$9.50
|
| Rate for Payer: Galaxy Health WC |
$20.18
|
| Rate for Payer: Global Benefits Group Commercial |
$14.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.70
|
| Rate for Payer: Multiplan Commercial |
$18.99
|
| Rate for Payer: Networks By Design Commercial |
$15.43
|
| Rate for Payer: Prime Health Services Commercial |
$20.18
|
|
|
HC SOM OROT 83921
|
Facility
|
IP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$20.04 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.43
|
| Rate for Payer: EPIC Health Plan Senior |
$9.43
|
| Rate for Payer: Galaxy Health WC |
$20.04
|
| Rate for Payer: Global Benefits Group Commercial |
$14.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: Multiplan Commercial |
$18.86
|
| Rate for Payer: Networks By Design Commercial |
$15.33
|
| Rate for Payer: Prime Health Services Commercial |
$20.04
|
|
|
HC SOM OROT 83921
|
Facility
|
OP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$162.52 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.52
|
| Rate for Payer: Blue Shield of California Commercial |
$15.78
|
| Rate for Payer: Blue Shield of California EPN |
$10.42
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cigna of CA HMO |
$15.09
|
| Rate for Payer: Cigna of CA PPO |
$17.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.63
|
| Rate for Payer: EPIC Health Plan Senior |
$21.21
|
| Rate for Payer: Galaxy Health WC |
$20.04
|
| Rate for Payer: Global Benefits Group Commercial |
$14.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$18.86
|
| Rate for Payer: Networks By Design Commercial |
$15.33
|
| Rate for Payer: Prime Health Services Commercial |
$20.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.29
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.45
|
| Rate for Payer: United Healthcare All Other HMO |
$41.45
|
| Rate for Payer: United Healthcare HMO Rider |
$41.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$115.64 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.64
|
| Rate for Payer: Blue Shield of California Commercial |
$27.43
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.30
|
| Rate for Payer: EPIC Health Plan Senior |
$29.85
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.18
|
| Rate for Payer: United Healthcare All Other HMO |
$24.18
|
| Rate for Payer: United Healthcare HMO Rider |
$24.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Vantage Medical Group Senior |
$29.85
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC SOM OXALATE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$127.14 |
| 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 |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.14
|
| 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 |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.51
|
| Rate for Payer: EPIC Health Plan Senior |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.36
|
| 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 |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
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 OXALATE PLASMA
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$127.14 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.14
|
| Rate for Payer: Blue Shield of California Commercial |
$45.49
|
| Rate for Payer: Blue Shield of California EPN |
$30.06
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.51
|
| Rate for Payer: EPIC Health Plan Senior |
$14.45
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE PLASMA
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$57.80 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$78.73 |
| 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 |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.73
|
| 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 |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| 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 |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
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 PANCREATIC ELASTASE/STOOL
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.84
|
| Rate for Payer: Blue Shield of California Commercial |
$53.52
|
| Rate for Payer: Blue Shield of California EPN |
$35.36
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$51.20
|
| Rate for Payer: Cigna of CA PPO |
$59.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.01
|
| Rate for Payer: EPIC Health Plan Senior |
$22.97
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.60
|
| Rate for Payer: United Healthcare All Other HMO |
$18.60
|
| Rate for Payer: United Healthcare HMO Rider |
$18.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.27
|
| Rate for Payer: Vantage Medical Group Senior |
$22.97
|
|
|
HC SOM PANCREATIC POLYPEPTIDE
|
Facility
|
OP
|
$555.29
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911326
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Adventist Health Commercial |
$111.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.21
|
| 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 |
$371.49
|
| Rate for Payer: Blue Shield of California EPN |
$245.44
|
| Rate for Payer: Cash Price |
$555.29
|
| Rate for Payer: Cash Price |
$555.29
|
| Rate for Payer: Cigna of CA HMO |
$355.39
|
| Rate for Payer: Cigna of CA PPO |
$410.91
|
| 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 |
$472.00
|
| Rate for Payer: Global Benefits Group Commercial |
$333.17
|
| 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 |
$370.38
|
| 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 |
$133.27
|
| 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 |
$444.23
|
| Rate for Payer: Networks By Design Commercial |
$360.94
|
| Rate for Payer: Prime Health Services Commercial |
$472.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.17
|
| 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
|
|
