|
HC SOM CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
IP
|
$1,204.78
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.96 |
| Max. Negotiated Rate |
$1,084.30 |
| Rate for Payer: Cash Price |
$542.15
|
| Rate for Payer: Central Health Plan Commercial |
$963.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.91
|
| Rate for Payer: Galaxy Health WC |
$1,024.06
|
| Rate for Payer: Global Benefits Group Commercial |
$722.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,084.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Multiplan Commercial |
$903.58
|
| Rate for Payer: Networks By Design Commercial |
$783.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.06
|
|
|
HC SOM CHROMOSOMES SKIN BIOPSY CULTURE
|
Facility
OP
|
$1,204.78
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.99 |
| Max. Negotiated Rate |
$1,084.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,060.09
|
| Rate for Payer: BCBS Transplant Transplant |
$722.87
|
| Rate for Payer: Blue Shield of California Commercial |
$744.55
|
| Rate for Payer: Blue Shield of California EPN |
$585.52
|
| Rate for Payer: Caremore Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$542.15
|
| Rate for Payer: Cash Price |
$542.15
|
| Rate for Payer: Central Health Plan Commercial |
$963.82
|
| Rate for Payer: Cigna of CA HMO |
$771.06
|
| Rate for Payer: Cigna of CA PPO |
$891.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$1,024.06
|
| Rate for Payer: Global Benefits Group Commercial |
$722.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,084.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$903.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: IEHP medi-cal |
$232.20
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Innovage PACE Commercial |
$211.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$903.58
|
| Rate for Payer: Networks By Design Commercial |
$783.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.06
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$722.87
|
| Rate for Payer: Riverside University Health MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC SOM CHRONIC URTICARIA INDEX
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 86343
|
| Hospital Charge Code |
900912840
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$96.00
|
| Rate for Payer: Blue Shield of California Commercial |
$98.88
|
| Rate for Payer: Blue Shield of California EPN |
$77.76
|
| Rate for Payer: Caremore Medicare Advantage |
$12.46
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$128.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.46
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.43
|
| Rate for Payer: IEHP medi-cal |
$20.56
|
| Rate for Payer: IEHP Medicare Advantage |
$12.46
|
| Rate for Payer: Innovage PACE Commercial |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Medicare |
$13.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: Riverside University Health MISP |
$13.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.09
|
| Rate for Payer: United Healthcare All Other HMO |
$10.09
|
| Rate for Payer: United Healthcare HMO Rider |
$10.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.71
|
| Rate for Payer: Vantage Medical Group Senior |
$12.46
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
IP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$155.74 |
| Rate for Payer: Cash Price |
$77.87
|
| Rate for Payer: Central Health Plan Commercial |
$138.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.22
|
| Rate for Payer: Galaxy Health WC |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.61
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
|
|
HC SOM CHRTI CULTURE 02
|
Facility
OP
|
$173.04
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915283
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$11,399.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,060.09
|
| Rate for Payer: BCBS Transplant Transplant |
$103.82
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$84.10
|
| Rate for Payer: Caremore Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$77.87
|
| Rate for Payer: Cash Price |
$77.87
|
| Rate for Payer: Central Health Plan Commercial |
$138.43
|
| Rate for Payer: Cigna of CA HMO |
$110.75
|
| Rate for Payer: Cigna of CA PPO |
$128.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$140.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$147.08
|
| Rate for Payer: Global Benefits Group Commercial |
$103.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$129.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: IEHP medi-cal |
$232.20
|
| Rate for Payer: IEHP Medicare Advantage |
$140.73
|
| Rate for Payer: Innovage PACE Commercial |
$211.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$188.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$129.78
|
| Rate for Payer: Networks By Design Commercial |
$112.48
|
| Rate for Payer: Prime Health Services Commercial |
$147.08
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$103.82
|
| Rate for Payer: Riverside University Health MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,399.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
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 |
$4,257.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,257.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: AlphaCare 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 |
$756.91
|
| Rate for Payer: BCBS Transplant Transplant |
$195.14
|
| Rate for Payer: Blue Shield of California Commercial |
$201.00
|
| Rate for Payer: Blue Shield of California EPN |
$158.07
|
| Rate for Payer: Caremore Medicare Advantage |
$250.78
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Cash Price |
$146.36
|
| 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: EPIC Health Plan Commercial |
$338.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$243.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$411.28
|
| Rate for Payer: IEHP medi-cal |
$413.79
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Prime Health Services Medicare |
$265.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$146.36
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
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: Cash Price |
$146.36
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$65.05 |
| Max. Negotiated Rate |
$920.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$920.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$178.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.72
|
| Rate for Payer: BCBS Transplant Transplant |
$195.14
|
| Rate for Payer: Blue Shield of California Commercial |
$201.00
|
| Rate for Payer: Blue Shield of California EPN |
$158.07
|
| Rate for Payer: Cash Price |
$146.36
|
| Rate for Payer: Cash Price |
$146.36
|
| 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: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$243.93
|
| Rate for Payer: IEHP medi-cal |
$113.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.94
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: Riverside University Health 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 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: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$246.67 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: AlphaCare 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 |
$246.67
|
| Rate for Payer: BCBS Transplant Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| 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: EPIC Health Plan Commercial |
$37.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.59
|
| Rate for Payer: IEHP medi-cal |
$45.87
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$29.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: Riverside University Health 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: 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
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: 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 CLONAZEPAM (CLONOPIN)
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.41
|
| 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: 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 |
$25.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$22.50
|
| Rate for Payer: IEHP medi-cal |
$10.50
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$25.50
|
| Rate for Payer: Vantage Medical Group Senior |
$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: Cash Price |
$14.22
|
| Rate for Payer: Central Health Plan Commercial |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$131.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: AlphaCare 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 |
$98.75
|
| Rate for Payer: BCBS Transplant Transplant |
$18.95
|
| Rate for Payer: Blue Shield of California Commercial |
$19.52
|
| Rate for Payer: Blue Shield of California EPN |
$15.35
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$14.22
|
| 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 |
$30.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$23.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: Innovage PACE Commercial |
$30.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.07
|
| 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: Prime Health Services Commercial |
$26.85
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.95
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$30.22
|
| 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 |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare 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 |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| 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 |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| 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: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$52.64
|
| 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: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$36.68
|
| 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
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: Cash Price |
$150.26
|
| Rate for Payer: Central Health Plan Commercial |
$267.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.56
|
| Rate for Payer: Galaxy Health WC |
$283.82
|
| 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: LLUH Dept of Risk Management WC |
$66.78
|
| Rate for Payer: Multiplan Commercial |
$250.42
|
| Rate for Payer: Networks By Design Commercial |
$217.04
|
| Rate for Payer: Prime Health Services Commercial |
$283.82
|
|
|
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 |
$314.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: AlphaCare 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 |
$229.58
|
| Rate for Payer: BCBS Transplant Transplant |
$200.34
|
| Rate for Payer: Blue Shield of California Commercial |
$206.35
|
| Rate for Payer: Blue Shield of California EPN |
$162.28
|
| Rate for Payer: Caremore Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$150.26
|
| Rate for Payer: Cash Price |
$150.26
|
| 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: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$283.82
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.51
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$250.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: IEHP medi-cal |
$70.69
|
| Rate for Payer: 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 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 |
$250.42
|
| Rate for Payer: Networks By Design Commercial |
$217.04
|
| Rate for Payer: Prime Health Services Commercial |
$283.82
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$200.34
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$9.76 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$185.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| 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 |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| 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: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: Riverside University Health 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 |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| 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 |
$9.76 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare 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 |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$185.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| 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 |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$225.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| 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: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: Riverside University Health 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 |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| 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: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$158.91 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: AlphaCare 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 |
$158.91
|
| Rate for Payer: BCBS Transplant Transplant |
$45.19
|
| Rate for Payer: Blue Shield of California Commercial |
$46.55
|
| Rate for Payer: Blue Shield of California EPN |
$36.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$33.89
|
| Rate for Payer: Cash Price |
$33.89
|
| 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: EPIC Health Plan Commercial |
$24.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$56.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: IEHP medi-cal |
$29.54
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$64.02
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$45.19
|
| Rate for Payer: Riverside University Health 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: 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
|
|
