|
HC SOM NMO/AQP4 FACS TITER
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915464
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| 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 |
$128.94
|
| Rate for Payer: Blue Shield of California Commercial |
$85.28
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| 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 |
$117.47
|
| 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 |
$44.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.31
|
| Rate for Payer: Blue Shield of California Commercial |
$142.88
|
| Rate for Payer: Blue Shield of California Commercial |
$94.50
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC SOMN NC08 CSF A-AMIN 82017
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914733
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$120.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC SOMN NC08 CSF A-AMIN 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914733
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$174.25 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.31
|
| Rate for Payer: Blue Shield of California Commercial |
$142.88
|
| Rate for Payer: Blue Shield of California Commercial |
$94.50
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$143.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$130.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900912685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$149.12 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.87
|
| Rate for Payer: Blue Shield of California Commercial |
$11.01
|
| Rate for Payer: Blue Shield of California Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cigna of CA HMO |
$10.11
|
| Rate for Payer: Cigna of CA PPO |
$11.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.25
|
| Rate for Payer: EPIC Health Plan Senior |
$22.16
|
| Rate for Payer: Galaxy Health WC |
$13.43
|
| Rate for Payer: Global Benefits Group Commercial |
$9.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$12.64
|
| Rate for Payer: Networks By Design Commercial |
$10.27
|
| Rate for Payer: Prime Health Services Commercial |
$13.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.33
|
| Rate for Payer: United Healthcare All Other HMO |
$16.33
|
| Rate for Payer: United Healthcare HMO Rider |
$16.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900912685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$13.43 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.32
|
| Rate for Payer: EPIC Health Plan Senior |
$6.32
|
| Rate for Payer: Galaxy Health WC |
$13.43
|
| Rate for Payer: Global Benefits Group Commercial |
$9.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$12.64
|
| Rate for Payer: Networks By Design Commercial |
$10.27
|
| Rate for Payer: Prime Health Services Commercial |
$13.43
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
OP
|
$42.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$19.69
|
| Rate for Payer: Blue Shield of California Commercial |
$29.78
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
IP
|
$42.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC SOM NOROVIRUS AG
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900914127
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$74.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC SOM NOROVIRUS AG
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900914127
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$58.09
|
| Rate for Payer: Blue Shield of California Commercial |
$87.82
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$88.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$80.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM NOROVIRUS RNA
|
Facility
|
IP
|
$245.52
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$208.69 |
| Rate for Payer: Adventist Health Commercial |
$49.10
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$171.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.21
|
| Rate for Payer: EPIC Health Plan Senior |
$98.21
|
| Rate for Payer: Galaxy Health WC |
$208.69
|
| Rate for Payer: Global Benefits Group Commercial |
$147.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$144.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.92
|
| Rate for Payer: Multiplan Commercial |
$196.42
|
| Rate for Payer: Networks By Design Commercial |
$159.59
|
| Rate for Payer: Prime Health Services Commercial |
$208.69
|
|
|
HC SOM NOROVIRUS RNA
|
Facility
|
OP
|
$245.52
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$49.10
|
| 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 |
$113.18
|
| Rate for Payer: Blue Shield of California Commercial |
$171.13
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Cigna of CA HMO |
$157.13
|
| Rate for Payer: Cigna of CA PPO |
$181.68
|
| 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 |
$171.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$208.69
|
| Rate for Payer: Global Benefits Group Commercial |
$147.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$155.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.92
|
| 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 |
$196.42
|
| Rate for Payer: Networks By Design Commercial |
$159.59
|
| Rate for Payer: Prime Health Services Commercial |
$208.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.31
|
| 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 N-TELOPEPTIDE CREATININE URINE
|
Facility
|
IP
|
$5.33
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915361
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
|
|
HC SOM N-TELOPEPTIDE CREATININE URINE
|
Facility
|
OP
|
$5.33
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915361
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$53.37 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Cigna of CA HMO |
$3.41
|
| Rate for Payer: Cigna of CA PPO |
$3.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.26
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM N-TELOPEPTIDE URINE
|
Facility
|
IP
|
$19.23
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900911412
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.69
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
|
|
HC SOM N-TELOPEPTIDE URINE
|
Facility
|
OP
|
$19.23
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900911412
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$284.42 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.42
|
| Rate for Payer: Blue Shield of California Commercial |
$13.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cigna of CA HMO |
$12.31
|
| Rate for Payer: Cigna of CA PPO |
$14.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.82
|
| Rate for Payer: EPIC Health Plan Senior |
$20.55
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.03
|
| Rate for Payer: Multiplan Commercial |
$15.38
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.13
|
| Rate for Payer: United Healthcare All Other HMO |
$15.13
|
| Rate for Payer: United Healthcare HMO Rider |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM NUCLEOPHOSMIN MUTAT ANAL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 81310
|
| Hospital Charge Code |
900914001
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM NUCLEOPHOSMIN MUTAT ANAL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 81310
|
| Hospital Charge Code |
900914001
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$406.76 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$387.89
|
| Rate for Payer: Blue Shield of California Commercial |
$161.35
|
| Rate for Payer: Blue Shield of California Commercial |
$243.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.76
|
| Rate for Payer: EPIC Health Plan Senior |
$271.17
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$404.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$331.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$374.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.34
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.68
|
| Rate for Payer: United Healthcare All Other HMO |
$199.68
|
| Rate for Payer: United Healthcare HMO Rider |
$199.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.17
|
| Rate for Payer: Vantage Medical Group Senior |
$246.52
|
|
|
HC SOM OLANZAPINE
|
Facility
|
IP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$79.73 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.52
|
| Rate for Payer: EPIC Health Plan Senior |
$37.52
|
| Rate for Payer: Galaxy Health WC |
$79.73
|
| Rate for Payer: Global Benefits Group Commercial |
$56.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$75.04
|
| Rate for Payer: Networks By Design Commercial |
$60.97
|
| Rate for Payer: Prime Health Services Commercial |
$79.73
|
|
|
HC SOM OLANZAPINE
|
Facility
|
OP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$43.24
|
| Rate for Payer: Blue Shield of California Commercial |
$65.38
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cigna of CA HMO |
$60.03
|
| Rate for Payer: Cigna of CA PPO |
$69.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$79.73
|
| Rate for Payer: Global Benefits Group Commercial |
$56.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$75.04
|
| Rate for Payer: Networks By Design Commercial |
$60.97
|
| Rate for Payer: Prime Health Services Commercial |
$79.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.99
|
| Rate for Payer: EPIC Health Plan Senior |
$9.99
|
| Rate for Payer: Galaxy Health WC |
$21.22
|
| Rate for Payer: Global Benefits Group Commercial |
$14.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| Rate for Payer: Multiplan Commercial |
$19.98
|
| Rate for Payer: Networks By Design Commercial |
$16.23
|
| Rate for Payer: Prime Health Services Commercial |
$21.22
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$207.49 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.27
|
| 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 |
$207.49
|
| Rate for Payer: Blue Shield of California Commercial |
$11.51
|
| Rate for Payer: Blue Shield of California Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cigna of CA HMO |
$15.98
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.19
|
| Rate for Payer: EPIC Health Plan Senior |
$30.13
|
| Rate for Payer: Galaxy Health WC |
$21.22
|
| Rate for Payer: Global Benefits Group Commercial |
$14.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.99
|
| 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 |
$19.98
|
| Rate for Payer: Networks By Design Commercial |
$16.23
|
| Rate for Payer: Prime Health Services Commercial |
$21.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.98
|
| 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
|
|
