|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$620.54 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$250.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$620.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.94
|
| Rate for Payer: Blue Shield of California Commercial |
$197.42
|
| Rate for Payer: Blue Shield of California EPN |
$129.12
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.55
|
| Rate for Payer: EPIC Health Plan Senior |
$250.78
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$411.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.78
|
| Rate for Payer: InnovAge PACE Commercial |
$376.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.05
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$250.78
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Prime Health Services Medicare |
$265.83
|
| Rate for Payer: Riverside University Health System MISP |
$275.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.13
|
| Rate for Payer: United Healthcare All Other HMO |
$203.13
|
| Rate for Payer: United Healthcare HMO Rider |
$203.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$250.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Vantage Medical Group Senior |
$250.78
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$197.42
|
| Rate for Payer: Blue Shield of California EPN |
$129.12
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: InnovAge PACE Commercial |
$162.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.67
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Riverside University Health System MISP |
$130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.62
|
| Rate for Payer: United Healthcare All Other HMO |
$162.62
|
| Rate for Payer: United Healthcare HMO Rider |
$162.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$276.45
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$202.23 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.04
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.53
|
| Rate for Payer: EPIC Health Plan Senior |
$27.80
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.80
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$29.47
|
| Rate for Payer: Riverside University Health System MISP |
$30.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.80
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$129.05 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.19
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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 |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: InnovAge PACE Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.00
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$12.00
|
| 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 |
$15.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15.00
|
| Rate for Payer: United Healthcare HMO Rider |
$15.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$25.50
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| 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 CLOZAPINE LEVEL
|
Facility
|
IP
|
$31.59
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$28.43 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Central Health Plan Commercial |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Senior |
$12.64
|
| Rate for Payer: Galaxy Health WC |
$26.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: Multiplan Commercial |
$23.69
|
| Rate for Payer: Networks By Design Commercial |
$20.53
|
| Rate for Payer: Prime Health Services Commercial |
$26.85
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
OP
|
$31.59
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Adventist Health Commercial |
$6.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.18
|
| 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 Exchange |
$80.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.43
|
| Rate for Payer: Blue Shield of California Commercial |
$19.18
|
| Rate for Payer: Blue Shield of California EPN |
$12.54
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Cash Price |
$31.59
|
| Rate for Payer: Central Health Plan Commercial |
$25.27
|
| Rate for Payer: Cigna of CA HMO |
$20.22
|
| Rate for Payer: Cigna of CA PPO |
$23.38
|
| 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: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$26.85
|
| Rate for Payer: Global Benefits Group Commercial |
$18.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: InnovAge PACE Commercial |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$23.69
|
| Rate for Payer: Networks By Design Commercial |
$20.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.85
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Riverside University Health System MISP |
$22.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.95
|
| 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 CMV PCR NON-BLOOD
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| 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 Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| 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: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| 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 CMV PCR NON-BLOOD
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM CMVQU 87497
|
Facility
|
OP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$300.51 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$202.68
|
| Rate for Payer: Blue Shield of California EPN |
$132.56
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Central Health Plan Commercial |
$267.12
|
| Rate for Payer: Cigna of CA HMO |
$213.70
|
| Rate for Payer: Cigna of CA PPO |
$247.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Networks By Design Commercial |
$217.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$283.81
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM CMVQU 87497
|
Facility
|
IP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$300.51 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Central Health Plan Commercial |
$267.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.56
|
| Rate for Payer: EPIC Health Plan Senior |
$133.56
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$222.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$127.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$206.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.78
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Networks By Design Commercial |
$217.03
|
| Rate for Payer: Prime Health Services Commercial |
$283.81
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$182.10
|
| Rate for Payer: Blue Shield of California EPN |
$119.10
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.80
|
| Rate for Payer: Blue Shield of California Commercial |
$182.10
|
| Rate for Payer: Blue Shield of California EPN |
$119.10
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
OP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$130.28 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.44
|
| Rate for Payer: Blue Shield of California Commercial |
$45.72
|
| Rate for Payer: Blue Shield of California EPN |
$29.90
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Central Health Plan Commercial |
$60.26
|
| Rate for Payer: Cigna of CA HMO |
$48.20
|
| Rate for Payer: Cigna of CA PPO |
$55.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Senior |
$17.90
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: InnovAge PACE Commercial |
$26.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$56.49
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
IP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$67.79 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Central Health Plan Commercial |
$60.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.13
|
| Rate for Payer: EPIC Health Plan Senior |
$30.13
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$56.49
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
|
|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
IP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$200.21 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Central Health Plan Commercial |
$177.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.98
|
| Rate for Payer: EPIC Health Plan Senior |
$88.98
|
| Rate for Payer: Galaxy Health WC |
$189.08
|
| Rate for Payer: Global Benefits Group Commercial |
$133.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.49
|
| Rate for Payer: Multiplan Commercial |
$166.84
|
| Rate for Payer: Networks By Design Commercial |
$144.59
|
| Rate for Payer: Prime Health Services Commercial |
$189.08
|
|
|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
OP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$200.21 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.01
|
| Rate for Payer: Blue Shield of California Commercial |
$135.03
|
| Rate for Payer: Blue Shield of California EPN |
$88.31
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Central Health Plan Commercial |
$177.96
|
| Rate for Payer: Cigna of CA HMO |
$142.37
|
| Rate for Payer: Cigna of CA PPO |
$164.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$189.08
|
| Rate for Payer: Global Benefits Group Commercial |
$133.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$166.84
|
| Rate for Payer: Networks By Design Commercial |
$144.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$189.08
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM COCCI AB IGG CSF BY CF
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM COCCI AB IGG CSF BY CF
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911338
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: InnovAge PACE Commercial |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
