|
HC SOM FMIS 83520
|
Facility
OP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$159.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: BCBS Transplant Transplant |
$106.64
|
| Rate for Payer: Blue Shield of California Commercial |
$109.84
|
| Rate for Payer: Blue Shield of California EPN |
$86.38
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Central Health Plan Commercial |
$142.18
|
| Rate for Payer: Cigna of CA HMO |
$113.75
|
| Rate for Payer: Cigna of CA PPO |
$131.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$151.07
|
| Rate for Payer: Global Benefits Group Commercial |
$106.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$133.30
|
| Rate for Payer: Networks By Design Commercial |
$115.52
|
| Rate for Payer: Prime Health Services Commercial |
$151.07
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$106.64
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FNTSM
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FNTSM
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.15
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$131.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492A
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.15
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$131.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492A
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FNTSM 82492B
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FNTSM 82492B
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$105.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.15
|
| Rate for Payer: Blue Shield of California EPN |
$85.05
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$131.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FOLATE, RBC
|
Facility
OP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$159.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.33
|
| Rate for Payer: BCBS Transplant Transplant |
$31.50
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$25.52
|
| Rate for Payer: Caremore Medicare Advantage |
$17.65
|
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: Central Health Plan Commercial |
$42.00
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$38.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.65
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.95
|
| Rate for Payer: IEHP medi-cal |
$29.12
|
| Rate for Payer: IEHP Medicare Advantage |
$17.65
|
| Rate for Payer: Innovage PACE Commercial |
$26.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$39.38
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$18.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.50
|
| Rate for Payer: Riverside University Health MISP |
$19.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14.30
|
| Rate for Payer: United Healthcare HMO Rider |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.42
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC SOM FOLATE, RBC
|
Facility
IP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Cash Price |
$23.63
|
| Rate for Payer: Central Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.00
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$39.38
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
|
|
HC SOM FPRSG 84150
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.83 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$41.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.46
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Caremore Medicare Advantage |
$41.77
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$41.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$41.77
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.50
|
| Rate for Payer: IEHP medi-cal |
$68.92
|
| Rate for Payer: IEHP Medicare Advantage |
$41.77
|
| Rate for Payer: Innovage PACE Commercial |
$62.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.97
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health MISP |
$45.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.83
|
| Rate for Payer: United Healthcare All Other HMO |
$33.83
|
| Rate for Payer: United Healthcare HMO Rider |
$33.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.77
|
|
|
HC SOM FPRSG 84150
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FPSAP 84153
|
Facility
OP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.21
|
| Rate for Payer: BCBS Transplant Transplant |
$53.70
|
| Rate for Payer: Blue Shield of California Commercial |
$55.31
|
| Rate for Payer: Blue Shield of California EPN |
$43.50
|
| Rate for Payer: Caremore Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$40.28
|
| Rate for Payer: Cash Price |
$40.28
|
| Rate for Payer: Central Health Plan Commercial |
$71.60
|
| Rate for Payer: Cigna of CA HMO |
$57.28
|
| Rate for Payer: Cigna of CA PPO |
$66.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$76.08
|
| Rate for Payer: Global Benefits Group Commercial |
$53.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: IEHP medi-cal |
$30.34
|
| Rate for Payer: IEHP Medicare Advantage |
$18.39
|
| Rate for Payer: Innovage PACE Commercial |
$27.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: Networks By Design Commercial |
$58.18
|
| Rate for Payer: Prime Health Services Commercial |
$76.08
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.70
|
| Rate for Payer: Riverside University Health MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM FPSAP 84153
|
Facility
IP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$80.55 |
| Rate for Payer: Cash Price |
$40.28
|
| Rate for Payer: Central Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.80
|
| Rate for Payer: Galaxy Health WC |
$76.08
|
| Rate for Payer: Global Benefits Group Commercial |
$53.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.90
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: Networks By Design Commercial |
$58.18
|
| Rate for Payer: Prime Health Services Commercial |
$76.08
|
|
|
HC SOM FQUET 82491
|
Facility
OP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$39.70
|
| Rate for Payer: Blue Shield of California Commercial |
$40.89
|
| Rate for Payer: Blue Shield of California EPN |
$32.15
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Central Health Plan Commercial |
$52.93
|
| Rate for Payer: Cigna of CA HMO |
$42.34
|
| Rate for Payer: Cigna of CA PPO |
$48.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$49.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$49.62
|
| Rate for Payer: Networks By Design Commercial |
$43.00
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39.70
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FQUET 82491
|
Facility
IP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: Cash Price |
$29.77
|
| Rate for Payer: Central Health Plan Commercial |
$52.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.46
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$49.62
|
| Rate for Payer: Networks By Design Commercial |
$43.00
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
|
|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
IP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$194.85 |
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Central Health Plan Commercial |
$173.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.60
|
| Rate for Payer: Galaxy Health WC |
$184.02
|
| Rate for Payer: Global Benefits Group Commercial |
$129.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.30
|
| Rate for Payer: Multiplan Commercial |
$162.38
|
| Rate for Payer: Networks By Design Commercial |
$140.72
|
| Rate for Payer: Prime Health Services Commercial |
$184.02
|
|
|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
OP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$44.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$67.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$44.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.44
|
| Rate for Payer: BCBS Transplant Transplant |
$129.90
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$105.22
|
| Rate for Payer: Caremore Medicare Advantage |
$44.89
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Cash Price |
$97.43
|
| Rate for Payer: Central Health Plan Commercial |
$173.20
|
| Rate for Payer: Cigna of CA HMO |
$138.56
|
| Rate for Payer: Cigna of CA PPO |
$160.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.60
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$44.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.89
|
| Rate for Payer: Galaxy Health WC |
$184.02
|
| Rate for Payer: Global Benefits Group Commercial |
$129.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$162.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$73.62
|
| Rate for Payer: IEHP medi-cal |
$74.07
|
| Rate for Payer: IEHP Medicare Advantage |
$44.89
|
| Rate for Payer: Innovage PACE Commercial |
$67.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$162.38
|
| Rate for Payer: Networks By Design Commercial |
$140.72
|
| Rate for Payer: Prime Health Services Commercial |
$184.02
|
| Rate for Payer: Prime Health Services Medicare |
$47.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$129.90
|
| Rate for Payer: Riverside University Health MISP |
$49.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.36
|
| Rate for Payer: United Healthcare All Other HMO |
$36.36
|
| Rate for Payer: United Healthcare HMO Rider |
$36.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Vantage Medical Group Senior |
$44.89
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$434.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$57.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$356.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$434.25
|
| Rate for Payer: BCBS Transplant Transplant |
$270.00
|
| Rate for Payer: Blue Shield of California Commercial |
$278.10
|
| Rate for Payer: Blue Shield of California EPN |
$218.70
|
| Rate for Payer: Caremore Medicare Advantage |
$57.04
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Central Health Plan Commercial |
$360.00
|
| Rate for Payer: Cigna of CA HMO |
$288.00
|
| Rate for Payer: Cigna of CA PPO |
$333.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$57.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$57.04
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$337.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$93.55
|
| Rate for Payer: IEHP medi-cal |
$94.12
|
| Rate for Payer: IEHP Medicare Advantage |
$57.04
|
| Rate for Payer: Innovage PACE Commercial |
$85.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.43
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
| Rate for Payer: Prime Health Services Medicare |
$60.46
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$270.00
|
| Rate for Payer: Riverside University Health MISP |
$62.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.21
|
| Rate for Payer: United Healthcare All Other HMO |
$46.21
|
| Rate for Payer: United Healthcare HMO Rider |
$46.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Vantage Medical Group Senior |
$57.04
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Central Health Plan Commercial |
$360.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
|
|
HC SOM FRANSICELLA AB
|
Facility
IP
|
$47.50
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Central Health Plan Commercial |
$38.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$40.38
|
| Rate for Payer: Global Benefits Group Commercial |
$28.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$35.62
|
| Rate for Payer: Networks By Design Commercial |
$30.88
|
| Rate for Payer: Prime Health Services Commercial |
$40.38
|
|
|
HC SOM FRANSICELLA AB
|
Facility
OP
|
$47.50
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911647
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$55.92 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.92
|
| Rate for Payer: BCBS Transplant Transplant |
$28.50
|
| Rate for Payer: Blue Shield of California Commercial |
$29.36
|
| Rate for Payer: Blue Shield of California EPN |
$23.08
|
| Rate for Payer: Caremore Medicare Advantage |
$6.98
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Central Health Plan Commercial |
$38.00
|
| Rate for Payer: Cigna of CA HMO |
$30.40
|
| Rate for Payer: Cigna of CA PPO |
$35.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$40.38
|
| Rate for Payer: Global Benefits Group Commercial |
$28.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$35.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.45
|
| Rate for Payer: IEHP medi-cal |
$11.52
|
| Rate for Payer: IEHP Medicare Advantage |
$6.98
|
| Rate for Payer: Innovage PACE Commercial |
$10.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$35.62
|
| Rate for Payer: Networks By Design Commercial |
$30.88
|
| Rate for Payer: Prime Health Services Commercial |
$40.38
|
| Rate for Payer: Prime Health Services Medicare |
$7.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.50
|
| Rate for Payer: Riverside University Health MISP |
$7.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC SOM FREE FATTY ACIDS
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$118.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.17
|
| Rate for Payer: BCBS Transplant Transplant |
$19.20
|
| Rate for Payer: Blue Shield of California Commercial |
$19.78
|
| Rate for Payer: Blue Shield of California EPN |
$15.55
|
| Rate for Payer: Caremore Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.77
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.78
|
| Rate for Payer: IEHP medi-cal |
$30.97
|
| Rate for Payer: IEHP Medicare Advantage |
$18.77
|
| Rate for Payer: Innovage PACE Commercial |
$28.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Prime Health Services Medicare |
$19.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: Riverside University Health MISP |
$20.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.20
|
| Rate for Payer: United Healthcare All Other HMO |
$15.20
|
| Rate for Payer: United Healthcare HMO Rider |
$15.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.77
|
|
|
HC SOM FREE FATTY ACIDS
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900914522
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
|
HC SOM FR TYR IDX BIND CAP
|
Facility
IP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.71
|
| Rate for Payer: Galaxy Health WC |
$7.88
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.88
|
|
|
HC SOM FR TYR IDX BIND CAP
|
Facility
OP
|
$9.27
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
900912805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.41
|
| Rate for Payer: BCBS Transplant Transplant |
$5.56
|
| Rate for Payer: Blue Shield of California Commercial |
$5.73
|
| Rate for Payer: Blue Shield of California EPN |
$4.51
|
| Rate for Payer: Caremore Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Central Health Plan Commercial |
$7.42
|
| Rate for Payer: Cigna of CA HMO |
$5.93
|
| Rate for Payer: Cigna of CA PPO |
$6.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$7.88
|
| Rate for Payer: Global Benefits Group Commercial |
$5.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: IEHP medi-cal |
$10.68
|
| Rate for Payer: IEHP Medicare Advantage |
$6.47
|
| Rate for Payer: Innovage PACE Commercial |
$9.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Networks By Design Commercial |
$6.03
|
| Rate for Payer: Prime Health Services Commercial |
$7.88
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.56
|
| Rate for Payer: Riverside University Health MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
