|
HC SOGDX 559 TP53 GENE 81405
|
Facility
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$2,091.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$301.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,714.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,091.26
|
| Rate for Payer: BCBS Transplant Transplant |
$837.00
|
| Rate for Payer: Blue Shield of California Commercial |
$862.11
|
| Rate for Payer: Blue Shield of California EPN |
$677.97
|
| Rate for Payer: Caremore Medicare Advantage |
$301.35
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,116.00
|
| Rate for Payer: Cigna of CA HMO |
$892.80
|
| Rate for Payer: Cigna of CA PPO |
$1,032.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$301.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$301.35
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,255.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,046.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: IEHP medi-cal |
$497.23
|
| Rate for Payer: IEHP Medicare Advantage |
$301.35
|
| Rate for Payer: Innovage PACE Commercial |
$452.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$930.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
| Rate for Payer: Prime Health Services Medicare |
$319.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$837.00
|
| Rate for Payer: Riverside University Health MISP |
$331.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$837.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$837.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOGDX 559 TP53 GENE 81405
|
Facility
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914849
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$279.00 |
| Max. Negotiated Rate |
$1,255.50 |
| Rate for Payer: Cash Price |
$627.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.00
|
| Rate for Payer: Galaxy Health WC |
$1,185.75
|
| Rate for Payer: Global Benefits Group Commercial |
$837.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,255.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$930.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.00
|
| Rate for Payer: Multiplan Commercial |
$1,046.25
|
| Rate for Payer: Networks By Design Commercial |
$906.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,185.75
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Central Health Plan Commercial |
$960.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$780.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
|
|
HC SOHAR HERED PARAGANG PHEO A
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914679
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,020.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$660.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$660.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$581.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$708.96
|
| Rate for Payer: BCBS Transplant Transplant |
$720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$741.60
|
| Rate for Payer: Blue Shield of California EPN |
$583.20
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Central Health Plan Commercial |
$960.00
|
| Rate for Payer: Cigna of CA HMO |
$768.00
|
| Rate for Payer: Cigna of CA PPO |
$888.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.00
|
| Rate for Payer: Galaxy Health WC |
$1,020.00
|
| Rate for Payer: Global Benefits Group Commercial |
$720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$900.00
|
| Rate for Payer: IEHP medi-cal |
$420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$780.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$720.00
|
| Rate for Payer: Riverside University Health MISP |
$480.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Other HMO |
$600.00
|
| Rate for Payer: United Healthcare HMO Rider |
$600.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$600.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
IP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
|
|
HC SOHAR HERED PARAGANG PHEO B
|
Facility
OP
|
$500.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914680
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$425.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$275.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$242.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.40
|
| Rate for Payer: BCBS Transplant Transplant |
$300.00
|
| Rate for Payer: Blue Shield of California Commercial |
$309.00
|
| Rate for Payer: Blue Shield of California EPN |
$243.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Central Health Plan Commercial |
$400.00
|
| Rate for Payer: Cigna of CA HMO |
$320.00
|
| Rate for Payer: Cigna of CA PPO |
$370.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$425.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$200.00
|
| Rate for Payer: Galaxy Health WC |
$425.00
|
| Rate for Payer: Global Benefits Group Commercial |
$300.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$450.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$375.00
|
| Rate for Payer: IEHP medi-cal |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$333.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.00
|
| Rate for Payer: Multiplan Commercial |
$375.00
|
| Rate for Payer: Networks By Design Commercial |
$325.00
|
| Rate for Payer: Prime Health Services Commercial |
$425.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: Riverside University Health MISP |
$200.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$300.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$300.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$250.00
|
| Rate for Payer: United Healthcare All Other HMO |
$250.00
|
| Rate for Payer: United Healthcare HMO Rider |
$250.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$425.00
|
| Rate for Payer: Vantage Medical Group Senior |
$425.00
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
IP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC SOHAR HERED PARAGANG PHEO C
|
Facility
OP
|
$850.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914681
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$722.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$467.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$467.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.18
|
| Rate for Payer: BCBS Transplant Transplant |
$510.00
|
| Rate for Payer: Blue Shield of California Commercial |
$525.30
|
| Rate for Payer: Blue Shield of California EPN |
$413.10
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Central Health Plan Commercial |
$680.00
|
| Rate for Payer: Cigna of CA HMO |
$544.00
|
| Rate for Payer: Cigna of CA PPO |
$629.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$765.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$637.50
|
| Rate for Payer: IEHP medi-cal |
$297.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$566.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.00
|
| Rate for Payer: Multiplan Commercial |
$637.50
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$510.00
|
| Rate for Payer: Riverside University Health MISP |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO |
$425.00
|
| Rate for Payer: United Healthcare HMO Rider |
$425.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$722.50
|
| Rate for Payer: Vantage Medical Group Senior |
$722.50
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
OP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
905353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$201.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$201.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$100.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.12
|
| Rate for Payer: BCBS Transplant Transplant |
$109.80
|
| Rate for Payer: Blue Shield of California Commercial |
$137.25
|
| Rate for Payer: Blue Shield of California EPN |
$99.55
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$137.25
|
| Rate for Payer: IEHP medi-cal |
$64.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.03
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Riverside University Health MISP |
$73.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.50
|
| Rate for Payer: United Healthcare All Other HMO |
$91.50
|
| Rate for Payer: United Healthcare HMO Rider |
$91.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC SOLE FULL SHOE ADD
|
Facility
IP
|
$183.00
|
|
|
Service Code
|
CPT L3540
|
| Hospital Charge Code |
905353540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Blue Shield of California EPN |
$97.72
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
OP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
905353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.49
|
| Rate for Payer: BCBS Transplant Transplant |
$72.60
|
| Rate for Payer: Blue Shield of California Commercial |
$90.75
|
| Rate for Payer: Blue Shield of California EPN |
$65.82
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.75
|
| Rate for Payer: IEHP medi-cal |
$42.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.61
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Riverside University Health MISP |
$48.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.50
|
| Rate for Payer: United Healthcare All Other HMO |
$60.50
|
| Rate for Payer: United Healthcare HMO Rider |
$60.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC SOLE HALF SHOE ADD
|
Facility
IP
|
$121.00
|
|
|
Service Code
|
CPT L3530
|
| Hospital Charge Code |
905353530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Blue Shield of California EPN |
$64.61
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$84.70
|
| Rate for Payer: Cigna of CA PPO |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$60.50
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
905353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$196.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$196.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$55.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: BCBS Transplant Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.00
|
| Rate for Payer: IEHP medi-cal |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC SOLE WEDGE BETWEEN SOLE
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT L3370
|
| Hospital Charge Code |
905353370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Blue Shield of California EPN |
$53.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
OP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
905353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$141.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$141.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.36
|
| Rate for Payer: BCBS Transplant Transplant |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.50
|
| Rate for Payer: Blue Shield of California EPN |
$38.08
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52.50
|
| Rate for Payer: IEHP medi-cal |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC SOLE WEDGE OUTSIDE SOLE
|
Facility
IP
|
$70.00
|
|
|
Service Code
|
CPT L3360
|
| Hospital Charge Code |
905353360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC SOLUBLE FIBRIN
|
Facility
IP
|
$121.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC SOLUBLE FIBRIN
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 85366
|
| Hospital Charge Code |
900910118
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$132.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$80.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$80.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.35
|
| Rate for Payer: BCBS Transplant Transplant |
$51.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.53
|
| Rate for Payer: Blue Shield of California EPN |
$41.31
|
| Rate for Payer: Caremore Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$80.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.46
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$131.95
|
| Rate for Payer: IEHP medi-cal |
$132.76
|
| Rate for Payer: IEHP Medicare Advantage |
$80.46
|
| Rate for Payer: Innovage PACE Commercial |
$120.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.82
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$85.29
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: Riverside University Health MISP |
$88.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.17
|
| Rate for Payer: United Healthcare All Other HMO |
$65.17
|
| Rate for Payer: United Healthcare HMO Rider |
$65.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.51
|
| Rate for Payer: Vantage Medical Group Senior |
$80.46
|
|
|
HC SOM 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$265.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$30.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.96
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$74.16
|
| Rate for Payer: Blue Shield of California EPN |
$58.32
|
| Rate for Payer: Caremore Medicare Advantage |
$30.98
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.98
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.81
|
| Rate for Payer: IEHP medi-cal |
$51.12
|
| Rate for Payer: IEHP Medicare Advantage |
$30.98
|
| Rate for Payer: Innovage PACE Commercial |
$46.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$32.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: Riverside University Health MISP |
$34.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM 11-DEOXYCORTISOL (COMPOUNDS)
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 82633
|
| Hospital Charge Code |
900911027
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
OP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$241.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$199.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.05
|
| Rate for Payer: BCBS Transplant Transplant |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$10.85
|
| Rate for Payer: Blue Shield of California EPN |
$8.53
|
| Rate for Payer: Caremore Medicare Advantage |
$27.17
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.17
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.56
|
| Rate for Payer: IEHP medi-cal |
$44.83
|
| Rate for Payer: IEHP Medicare Advantage |
$27.17
|
| Rate for Payer: Innovage PACE Commercial |
$40.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.41
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Prime Health Services Medicare |
$28.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: Riverside University Health MISP |
$29.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
|
HC SOM 17-OH-PROGESTERONE
|
Facility
IP
|
$17.55
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900911017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
HC SOM 18-OH CORTICOSTERONE
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
|
|
HC SOM 18-OH CORTICOSTERONE
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$104.44
|
| Rate for Payer: Blue Shield of California EPN |
$82.13
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM 199PC 86301
|
Facility
IP
|
$29.81
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
900914879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$26.83 |
| Rate for Payer: Cash Price |
$13.41
|
| Rate for Payer: Central Health Plan Commercial |
$23.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.92
|
| Rate for Payer: Galaxy Health WC |
$25.34
|
| Rate for Payer: Global Benefits Group Commercial |
$17.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$22.36
|
| Rate for Payer: Networks By Design Commercial |
$19.38
|
| Rate for Payer: Prime Health Services Commercial |
$25.34
|
|
