|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.66
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: IEHP medi-cal |
$34.34
|
| Rate for Payer: IEHP Medicare Advantage |
$20.81
|
| Rate for Payer: Innovage PACE Commercial |
$31.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Riverside University Health MISP |
$22.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
IP
|
$250.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| 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 |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Caremore Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$160.00
|
| Rate for Payer: Cigna of CA PPO |
$185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$187.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: IEHP medi-cal |
$36.58
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Innovage PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: Riverside University Health MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM ALUMINUM
|
Facility
IP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$15.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
|
|
HC SOM ALUMINUM
|
Facility
OP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$226.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.12
|
| Rate for Payer: BCBS Transplant Transplant |
$11.99
|
| Rate for Payer: Blue Shield of California Commercial |
$12.35
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$25.48
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$15.99
|
| Rate for Payer: Cigna of CA HMO |
$12.79
|
| Rate for Payer: Cigna of CA PPO |
$14.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.48
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.79
|
| Rate for Payer: IEHP medi-cal |
$42.04
|
| Rate for Payer: IEHP Medicare Advantage |
$25.48
|
| Rate for Payer: Innovage PACE Commercial |
$38.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.14
|
| Rate for Payer: Multiplan Commercial |
$14.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
| Rate for Payer: Prime Health Services Medicare |
$27.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.99
|
| Rate for Payer: Riverside University Health MISP |
$28.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.64
|
| Rate for Payer: United Healthcare All Other HMO |
$20.64
|
| Rate for Payer: United Healthcare HMO Rider |
$20.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Vantage Medical Group Senior |
$25.48
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$108.85 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.85
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Caremore Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.32
|
| Rate for Payer: IEHP medi-cal |
$20.44
|
| Rate for Payer: IEHP Medicare Advantage |
$12.39
|
| Rate for Payer: Innovage PACE Commercial |
$18.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$13.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: Riverside University Health MISP |
$13.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.04
|
| Rate for Payer: United Healthcare All Other HMO |
$10.04
|
| Rate for Payer: United Healthcare HMO Rider |
$10.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC SOM AMINO ACID QUANT UR RANDOM
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$148.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.99
|
| Rate for Payer: BCBS Transplant Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.60
|
| Rate for Payer: Caremore Medicare Advantage |
$16.87
|
| 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 |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.87
|
| 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: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: IEHP medi-cal |
$27.84
|
| Rate for Payer: IEHP Medicare Advantage |
$16.87
|
| Rate for Payer: Innovage PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: Riverside University Health MISP |
$18.56
|
| 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 |
$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: 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 AMINO ACID QUANT UR RANDOM
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$148.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.99
|
| Rate for Payer: BCBS Transplant Transplant |
$45.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.35
|
| Rate for Payer: Blue Shield of California EPN |
$36.45
|
| Rate for Payer: Caremore Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: IEHP medi-cal |
$27.84
|
| Rate for Payer: IEHP Medicare Advantage |
$16.87
|
| Rate for Payer: Innovage PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: Riverside University Health MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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: 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 AMINO ACIDS PLASMA
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM AMIODARONE
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM AMIODARONE
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: BCBS Transplant Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: IEHP medi-cal |
$30.76
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Innovage PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: Riverside University Health MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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: 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 AMITRIPTYLINE LEVEL
|
Facility
OP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$211.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$199.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$129.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$129.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.34
|
| Rate for Payer: BCBS Transplant Transplant |
$140.90
|
| Rate for Payer: Blue Shield of California Commercial |
$145.12
|
| Rate for Payer: Blue Shield of California EPN |
$114.13
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Central Health Plan Commercial |
$187.86
|
| Rate for Payer: Cigna of CA HMO |
$150.29
|
| Rate for Payer: Cigna of CA PPO |
$173.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.93
|
| Rate for Payer: Galaxy Health WC |
$199.61
|
| Rate for Payer: Global Benefits Group Commercial |
$140.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$176.12
|
| Rate for Payer: IEHP medi-cal |
$82.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.97
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: Networks By Design Commercial |
$152.64
|
| Rate for Payer: Prime Health Services Commercial |
$199.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$140.90
|
| Rate for Payer: Riverside University Health MISP |
$93.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.42
|
| Rate for Payer: United Healthcare All Other HMO |
$117.42
|
| Rate for Payer: United Healthcare HMO Rider |
$117.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.61
|
| Rate for Payer: Vantage Medical Group Senior |
$199.61
|
|
|
HC SOM AMITRIPTYLINE LEVEL
|
Facility
IP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$211.35 |
| Rate for Payer: Cash Price |
$105.67
|
| Rate for Payer: Central Health Plan Commercial |
$187.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.93
|
| Rate for Payer: Galaxy Health WC |
$199.61
|
| Rate for Payer: Global Benefits Group Commercial |
$140.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.97
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: Networks By Design Commercial |
$152.64
|
| Rate for Payer: Prime Health Services Commercial |
$199.61
|
|
|
HC SOM AMOBARBITAL
|
Facility
OP
|
$272.21
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$244.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$231.38
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$149.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$149.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.50
|
| Rate for Payer: BCBS Transplant Transplant |
$163.33
|
| Rate for Payer: Blue Shield of California Commercial |
$168.23
|
| Rate for Payer: Blue Shield of California EPN |
$132.29
|
| Rate for Payer: Cash Price |
$122.49
|
| Rate for Payer: Cash Price |
$122.49
|
| Rate for Payer: Central Health Plan Commercial |
$217.77
|
| Rate for Payer: Cigna of CA HMO |
$174.21
|
| Rate for Payer: Cigna of CA PPO |
$201.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.88
|
| Rate for Payer: Galaxy Health WC |
$231.38
|
| Rate for Payer: Global Benefits Group Commercial |
$163.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.99
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$204.16
|
| Rate for Payer: IEHP medi-cal |
$95.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.44
|
| Rate for Payer: Multiplan Commercial |
$204.16
|
| Rate for Payer: Networks By Design Commercial |
$176.94
|
| Rate for Payer: Prime Health Services Commercial |
$231.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$163.33
|
| Rate for Payer: Riverside University Health MISP |
$108.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.10
|
| Rate for Payer: United Healthcare All Other HMO |
$136.10
|
| Rate for Payer: United Healthcare HMO Rider |
$136.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.38
|
| Rate for Payer: Vantage Medical Group Senior |
$231.38
|
|
|
HC SOM AMOBARBITAL
|
Facility
IP
|
$272.21
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.44 |
| Max. Negotiated Rate |
$244.99 |
| Rate for Payer: Cash Price |
$122.49
|
| Rate for Payer: Central Health Plan Commercial |
$217.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.88
|
| Rate for Payer: Galaxy Health WC |
$231.38
|
| Rate for Payer: Global Benefits Group Commercial |
$163.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.44
|
| Rate for Payer: Multiplan Commercial |
$204.16
|
| Rate for Payer: Networks By Design Commercial |
$176.94
|
| Rate for Payer: Prime Health Services Commercial |
$231.38
|
|
|
HC SOM AMOXAPINE
|
Facility
OP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$36.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.34
|
| Rate for Payer: BCBS Transplant Transplant |
$39.28
|
| Rate for Payer: Blue Shield of California Commercial |
$40.45
|
| Rate for Payer: Blue Shield of California EPN |
$31.81
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Central Health Plan Commercial |
$52.37
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$48.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$49.10
|
| Rate for Payer: IEHP medi-cal |
$22.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$49.10
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39.28
|
| Rate for Payer: Riverside University Health MISP |
$26.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.73
|
| Rate for Payer: United Healthcare All Other HMO |
$32.73
|
| Rate for Payer: United Healthcare HMO Rider |
$32.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.64
|
| Rate for Payer: Vantage Medical Group Senior |
$55.64
|
|
|
HC SOM AMOXAPINE
|
Facility
IP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$58.91 |
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Central Health Plan Commercial |
$52.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$49.10
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
OP
|
$20.78
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$145.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.53
|
| Rate for Payer: BCBS Transplant Transplant |
$12.47
|
| Rate for Payer: Blue Shield of California Commercial |
$12.84
|
| Rate for Payer: Blue Shield of California EPN |
$10.10
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: Cigna of CA HMO |
$13.30
|
| Rate for Payer: Cigna of CA PPO |
$15.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.31
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.58
|
| Rate for Payer: IEHP medi-cal |
$7.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$15.58
|
| Rate for Payer: Networks By Design Commercial |
$13.51
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.47
|
| Rate for Payer: Riverside University Health MISP |
$8.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.39
|
| Rate for Payer: United Healthcare All Other HMO |
$10.39
|
| Rate for Payer: United Healthcare HMO Rider |
$10.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Vantage Medical Group Senior |
$17.66
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
IP
|
$20.78
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$15.58
|
| Rate for Payer: Networks By Design Commercial |
$13.51
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
|
|
HC SOM AMYLASE ISOENZYMES
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: IEHP medi-cal |
$10.69
|
| Rate for Payer: IEHP Medicare Advantage |
$6.48
|
| Rate for Payer: Innovage PACE Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC SOM AMYLASE ISOENZYMES
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900910241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
