|
HC SOM LIPASE RANDOM URINE
|
Facility
OP
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.05
|
| Rate for Payer: BCBS Transplant Transplant |
$40.26
|
| Rate for Payer: Blue Shield of California Commercial |
$41.47
|
| Rate for Payer: Blue Shield of California EPN |
$32.61
|
| Rate for Payer: Caremore Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$30.20
|
| Rate for Payer: Cash Price |
$30.20
|
| Rate for Payer: Central Health Plan Commercial |
$53.68
|
| Rate for Payer: Cigna of CA HMO |
$42.94
|
| Rate for Payer: Cigna of CA PPO |
$49.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$57.04
|
| Rate for Payer: Global Benefits Group Commercial |
$40.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$50.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: IEHP medi-cal |
$11.37
|
| Rate for Payer: IEHP Medicare Advantage |
$6.89
|
| Rate for Payer: Innovage PACE Commercial |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$50.32
|
| Rate for Payer: Networks By Design Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$57.04
|
| Rate for Payer: Prime Health Services Medicare |
$7.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$40.26
|
| Rate for Payer: Riverside University Health MISP |
$7.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
IP
|
$14.65
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Central Health Plan Commercial |
$11.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.86
|
| Rate for Payer: Galaxy Health WC |
$12.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$10.99
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$12.45
|
|
|
HC SOM LIPOPROTEIN A
|
Facility
OP
|
$14.65
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
900910756
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$112.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.37
|
| Rate for Payer: BCBS Transplant Transplant |
$8.79
|
| Rate for Payer: Blue Shield of California Commercial |
$9.05
|
| Rate for Payer: Blue Shield of California EPN |
$7.12
|
| Rate for Payer: Caremore Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Cash Price |
$6.59
|
| Rate for Payer: Central Health Plan Commercial |
$11.72
|
| Rate for Payer: Cigna of CA HMO |
$9.38
|
| Rate for Payer: Cigna of CA PPO |
$10.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.33
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.32
|
| Rate for Payer: Galaxy Health WC |
$12.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.48
|
| Rate for Payer: IEHP medi-cal |
$23.63
|
| Rate for Payer: IEHP Medicare Advantage |
$14.32
|
| Rate for Payer: Innovage PACE Commercial |
$21.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.19
|
| Rate for Payer: Multiplan Commercial |
$10.99
|
| Rate for Payer: Networks By Design Commercial |
$9.52
|
| Rate for Payer: Prime Health Services Commercial |
$12.45
|
| Rate for Payer: Prime Health Services Medicare |
$15.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.79
|
| Rate for Payer: Riverside University Health MISP |
$15.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.60
|
| Rate for Payer: United Healthcare All Other HMO |
$11.60
|
| Rate for Payer: United Healthcare HMO Rider |
$11.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$14.32
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$191.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.65
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.49
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.40
|
| Rate for Payer: IEHP medi-cal |
$25.56
|
| Rate for Payer: IEHP Medicare Advantage |
$15.49
|
| Rate for Payer: Innovage PACE Commercial |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.76
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Riverside University Health MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Vantage Medical Group Senior |
$15.49
|
|
|
HC SOM LYME DISEASE AB IGG
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM LYME DISEASE AB IGM
|
Facility
OP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$191.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$157.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.65
|
| Rate for Payer: BCBS Transplant Transplant |
$9.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.29
|
| Rate for Payer: Caremore Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.49
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.40
|
| Rate for Payer: IEHP medi-cal |
$25.56
|
| Rate for Payer: IEHP Medicare Advantage |
$15.49
|
| Rate for Payer: Innovage PACE Commercial |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.76
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.42
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: Riverside University Health MISP |
$17.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.55
|
| Rate for Payer: United Healthcare All Other HMO |
$12.55
|
| Rate for Payer: United Healthcare HMO Rider |
$12.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Vantage Medical Group Senior |
$15.49
|
|
|
HC SOM LYME DISEASE AB IGM
|
Facility
IP
|
$15.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
IP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Central Health Plan Commercial |
$13.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
OP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$142.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.96
|
| Rate for Payer: BCBS Transplant Transplant |
$9.78
|
| Rate for Payer: Blue Shield of California Commercial |
$10.07
|
| Rate for Payer: Blue Shield of California EPN |
$7.92
|
| Rate for Payer: Caremore Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Central Health Plan Commercial |
$13.04
|
| Rate for Payer: Cigna of CA HMO |
$10.43
|
| Rate for Payer: Cigna of CA PPO |
$12.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.93
|
| Rate for Payer: IEHP medi-cal |
$28.10
|
| Rate for Payer: IEHP Medicare Advantage |
$17.03
|
| Rate for Payer: Innovage PACE Commercial |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
| Rate for Payer: Prime Health Services Medicare |
$18.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.78
|
| Rate for Payer: Riverside University Health MISP |
$18.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13.80
|
| Rate for Payer: United Healthcare HMO Rider |
$13.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: BCBS Transplant Transplant |
$78.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.34
|
| Rate for Payer: Blue Shield of California EPN |
$63.18
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$97.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: IEHP medi-cal |
$24.73
|
| Rate for Payer: IEHP Medicare Advantage |
$14.99
|
| Rate for Payer: Innovage PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: Riverside University Health MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC SOM LYSO 86003
|
Facility
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM LYSO 86003
|
Facility
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: BCBS Transplant Transplant |
$4.48
|
| Rate for Payer: Blue Shield of California Commercial |
$4.62
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Cash Price |
$3.36
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: IEHP medi-cal |
$8.61
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Innovage PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: Riverside University Health MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
IP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Central Health Plan Commercial |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.30
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
OP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$59.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: BCBS Transplant Transplant |
$4.45
|
| Rate for Payer: Blue Shield of California Commercial |
$4.58
|
| Rate for Payer: Blue Shield of California EPN |
$3.60
|
| Rate for Payer: Caremore Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Central Health Plan Commercial |
$5.93
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$5.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: Galaxy Health WC |
$6.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.67
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: IEHP medi-cal |
$11.06
|
| Rate for Payer: IEHP Medicare Advantage |
$6.70
|
| Rate for Payer: Innovage PACE Commercial |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.30
|
| Rate for Payer: Prime Health Services Medicare |
$7.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: Riverside University Health MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$59.08 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: BCBS Transplant Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.70
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: IEHP medi-cal |
$11.06
|
| Rate for Payer: IEHP Medicare Advantage |
$6.70
|
| Rate for Payer: Innovage PACE Commercial |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$7.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: Riverside University Health MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM MANGANESE
|
Facility
OP
|
$26.65
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$218.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$26.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$178.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.17
|
| Rate for Payer: BCBS Transplant Transplant |
$15.99
|
| Rate for Payer: Blue Shield of California Commercial |
$16.47
|
| Rate for Payer: Blue Shield of California EPN |
$12.95
|
| Rate for Payer: Caremore Medicare Advantage |
$26.65
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Central Health Plan Commercial |
$21.32
|
| Rate for Payer: Cigna of CA HMO |
$17.06
|
| Rate for Payer: Cigna of CA PPO |
$19.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.65
|
| Rate for Payer: Galaxy Health WC |
$22.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.71
|
| Rate for Payer: IEHP medi-cal |
$43.97
|
| Rate for Payer: IEHP Medicare Advantage |
$26.65
|
| Rate for Payer: Innovage PACE Commercial |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.71
|
| Rate for Payer: Multiplan Commercial |
$19.99
|
| Rate for Payer: Networks By Design Commercial |
$17.32
|
| Rate for Payer: Prime Health Services Commercial |
$22.65
|
| Rate for Payer: Prime Health Services Medicare |
$28.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.99
|
| Rate for Payer: Riverside University Health MISP |
$29.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.59
|
| Rate for Payer: United Healthcare All Other HMO |
$21.59
|
| Rate for Payer: United Healthcare HMO Rider |
$21.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Vantage Medical Group Senior |
$26.65
|
|
|
HC SOM MANGANESE
|
Facility
IP
|
$26.65
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$23.98 |
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Central Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.66
|
| Rate for Payer: Galaxy Health WC |
$22.65
|
| Rate for Payer: Global Benefits Group Commercial |
$15.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.33
|
| Rate for Payer: Multiplan Commercial |
$19.99
|
| Rate for Payer: Networks By Design Commercial |
$17.32
|
| Rate for Payer: Prime Health Services Commercial |
$22.65
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
IP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
OP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$18,878.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$233.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,656.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$349.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,116.59
|
| Rate for Payer: BCBS Transplant Transplant |
$276.00
|
| Rate for Payer: Blue Shield of California Commercial |
$284.28
|
| Rate for Payer: Blue Shield of California EPN |
$223.56
|
| Rate for Payer: Caremore Medicare Advantage |
$233.07
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.64
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$233.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$233.07
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$345.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$382.23
|
| Rate for Payer: IEHP medi-cal |
$384.57
|
| Rate for Payer: IEHP Medicare Advantage |
$233.07
|
| Rate for Payer: Innovage PACE Commercial |
$349.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$312.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Medicare |
$247.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: Riverside University Health MISP |
$256.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$188.78
|
| Rate for Payer: United Healthcare HMO Rider |
$188.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,878.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
IP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$46.21 |
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$41.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.54
|
| Rate for Payer: Galaxy Health WC |
$43.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.27
|
| Rate for Payer: Multiplan Commercial |
$38.50
|
| Rate for Payer: Networks By Design Commercial |
$33.37
|
| Rate for Payer: Prime Health Services Commercial |
$43.64
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
OP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,505.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,505.45
|
| Rate for Payer: BCBS Transplant Transplant |
$30.80
|
| Rate for Payer: Blue Shield of California Commercial |
$31.73
|
| Rate for Payer: Blue Shield of California EPN |
$24.95
|
| Rate for Payer: Caremore Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$41.07
|
| Rate for Payer: Cigna of CA HMO |
$32.86
|
| Rate for Payer: Cigna of CA PPO |
$37.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$43.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: IEHP medi-cal |
$35.34
|
| Rate for Payer: IEHP Medicare Advantage |
$21.42
|
| Rate for Payer: Innovage PACE Commercial |
$32.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$38.50
|
| Rate for Payer: Networks By Design Commercial |
$33.37
|
| Rate for Payer: Prime Health Services Commercial |
$43.64
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.80
|
| Rate for Payer: Riverside University Health MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
IP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$56.22 |
| Rate for Payer: Cash Price |
$28.11
|
| Rate for Payer: Central Health Plan Commercial |
$49.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.99
|
| Rate for Payer: Galaxy Health WC |
$53.10
|
| Rate for Payer: Global Benefits Group Commercial |
$37.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
| Rate for Payer: Networks By Design Commercial |
$40.61
|
| Rate for Payer: Prime Health Services Commercial |
$53.10
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
OP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$2,322.69 |
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,322.69
|
| Rate for Payer: BCBS Transplant Transplant |
$37.48
|
| Rate for Payer: Blue Shield of California Commercial |
$38.61
|
| Rate for Payer: Blue Shield of California EPN |
$30.36
|
| Rate for Payer: Caremore Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$28.11
|
| Rate for Payer: Cash Price |
$28.11
|
| Rate for Payer: Central Health Plan Commercial |
$49.98
|
| Rate for Payer: Cigna of CA HMO |
$39.98
|
| Rate for Payer: Cigna of CA PPO |
$46.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.19
|
| Rate for Payer: Galaxy Health WC |
$53.10
|
| Rate for Payer: Global Benefits Group Commercial |
$37.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$46.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: IEHP medi-cal |
$84.46
|
| Rate for Payer: IEHP Medicare Advantage |
$51.19
|
| Rate for Payer: Innovage PACE Commercial |
$76.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
| Rate for Payer: Networks By Design Commercial |
$40.61
|
| Rate for Payer: Prime Health Services Commercial |
$53.10
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$37.48
|
| Rate for Payer: Riverside University Health MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
