|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
IP
|
$26.28
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.51
|
| Rate for Payer: EPIC Health Plan Senior |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$22.34
|
| Rate for Payer: Global Benefits Group Commercial |
$15.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.31
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: Prime Health Services Commercial |
$22.34
|
|
|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
OP
|
$26.28
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Shield of California Commercial |
$12.12
|
| Rate for Payer: Blue Shield of California Commercial |
$18.32
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cigna of CA HMO |
$16.82
|
| Rate for Payer: Cigna of CA PPO |
$19.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$22.34
|
| Rate for Payer: Global Benefits Group Commercial |
$15.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: Prime Health Services Commercial |
$22.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SOM NEOPTERIN
|
Facility
|
OP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$152.36 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| 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 |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$124.94
|
| Rate for Payer: Blue Shield of California Commercial |
$82.63
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cigna of CA HMO |
$114.72
|
| Rate for Payer: Cigna of CA PPO |
$132.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$152.36
|
| Rate for Payer: Global Benefits Group Commercial |
$107.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$113.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.02
|
| 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 |
$143.40
|
| Rate for Payer: Networks By Design Commercial |
$116.51
|
| Rate for Payer: Prime Health Services Commercial |
$152.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.55
|
| 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 NEOPTERIN
|
Facility
|
IP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$152.36 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.70
|
| Rate for Payer: EPIC Health Plan Senior |
$71.70
|
| Rate for Payer: Galaxy Health WC |
$152.36
|
| Rate for Payer: Global Benefits Group Commercial |
$107.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.02
|
| Rate for Payer: Multiplan Commercial |
$143.40
|
| Rate for Payer: Networks By Design Commercial |
$116.51
|
| Rate for Payer: Prime Health Services Commercial |
$152.36
|
|
|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| 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 |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$17.06
|
| Rate for Payer: Blue Shield of California Commercial |
$25.79
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| 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 |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| 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 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 CSF
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$31.45 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| 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 |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| 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 |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 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 |
$112.35
|
| 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 |
$139.46
|
| Rate for Payer: Blue Shield of California Commercial |
$124.47
|
| Rate for Payer: Blue Shield of California Commercial |
$188.19
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.76
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| 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 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 |
$185.61 |
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| 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 |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$135.91
|
| Rate for Payer: Blue Shield of California Commercial |
$89.89
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| 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: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.05
|
| 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
|
$26.27
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$22.33 |
| Rate for Payer: Adventist Health Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.51
|
| Rate for Payer: EPIC Health Plan Senior |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$22.33
|
| Rate for Payer: Global Benefits Group Commercial |
$15.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: Prime Health Services Commercial |
$22.33
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
OP
|
$26.27
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$5.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| 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 |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$12.11
|
| Rate for Payer: Blue Shield of California Commercial |
$18.31
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Cigna of CA HMO |
$16.81
|
| Rate for Payer: Cigna of CA PPO |
$19.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$22.33
|
| Rate for Payer: Global Benefits Group Commercial |
$15.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| 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 |
$21.02
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: Prime Health Services Commercial |
$22.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.76
|
| 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
|
OP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$297.20 |
| Rate for Payer: Multiplan Commercial |
$16.28
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| 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 |
$297.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.18
|
| Rate for Payer: Blue Shield of California Commercial |
$9.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.01
|
| 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: 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.01
|
| 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 NITROGEN STOOL
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$57.18 |
| Rate for Payer: Adventist Health Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$67.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.91
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$57.18
|
| Rate for Payer: Global Benefits Group Commercial |
$40.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.14
|
| Rate for Payer: Multiplan Commercial |
$53.82
|
| Rate for Payer: Networks By Design Commercial |
$43.73
|
| Rate for Payer: Prime Health Services Commercial |
$57.18
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
OP
|
$67.27
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$57.18 |
| Rate for Payer: Adventist Health Commercial |
$13.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.17
|
| Rate for Payer: Blue Shield of California Commercial |
$31.01
|
| Rate for Payer: Blue Shield of California Commercial |
$46.89
|
| Rate for Payer: Cash Price |
$67.27
|
| Rate for Payer: Cigna of CA HMO |
$43.05
|
| Rate for Payer: Cigna of CA PPO |
$49.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.91
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$57.18
|
| Rate for Payer: Global Benefits Group Commercial |
$40.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.09
|
| Rate for Payer: Multiplan Commercial |
$53.82
|
| Rate for Payer: Networks By Design Commercial |
$43.73
|
| Rate for Payer: Prime Health Services Commercial |
$57.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.63
|
| Rate for Payer: United Healthcare All Other HMO |
$33.63
|
| Rate for Payer: United Healthcare HMO Rider |
$33.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.18
|
| Rate for Payer: Vantage Medical Group Senior |
$57.18
|
|
|
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: Cigna of CA PPO |
$254.80
|
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| 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 |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$158.74
|
| Rate for Payer: Blue Shield of California Commercial |
$240.00
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$241.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$292.68
|
| Rate for Payer: Global Benefits Group Commercial |
$206.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$218.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$241.03
|
| 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 Foundation Hospitals Commercial/Self Funded |
$218.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.15
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.72
|
| 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 Foundation Hospitals Commercial/Self Funded |
$103.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.85
|
| 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 |
$185.61 |
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| 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 |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$113.23
|
| Rate for Payer: Blue Shield of California Commercial |
$74.89
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$138.08
|
| Rate for Payer: Global Benefits Group Commercial |
$97.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$103.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| 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
|
|
|
HC SOM NMO/AQP4 FACS
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Adventist Health Commercial |
$68.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.19
|
| 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 |
$35.02
|
| Rate for Payer: Blue Shield of California Commercial |
$156.74
|
| Rate for Payer: Blue Shield of California Commercial |
$236.98
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna of CA HMO |
$217.60
|
| Rate for Payer: Cigna of CA PPO |
$251.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$204.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$215.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| 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 |
$272.00
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$289.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$204.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.00
|
| 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 SOM NMO/AQP4 FACS
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Adventist Health Commercial |
$68.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Senior |
$136.00
|
| Rate for Payer: Galaxy Health WC |
$289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$204.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.60
|
| Rate for Payer: Multiplan Commercial |
$272.00
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$289.00
|
|
|
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 |
$71.19 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.19
|
| 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 |
$35.02
|
| Rate for Payer: Blue Shield of California Commercial |
$34.58
|
| Rate for Payer: Blue Shield of California Commercial |
$52.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| 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
|
|
