|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Adventist Health Commercial |
$37.00
|
| Rate for Payer: Cash Price |
$101.75
|
| Rate for Payer: Central Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.00
|
| Rate for Payer: EPIC Health Plan Senior |
$74.00
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.79
|
| Rate for Payer: Blue Shield of California Commercial |
$124.44
|
| Rate for Payer: Blue Shield of California EPN |
$81.39
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: InnovAge PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOMN NC07 CSF SIALIC 82017
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914735
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC SOMN NC08 CSF A-AMIN 82017
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914733
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.79
|
| Rate for Payer: Blue Shield of California Commercial |
$124.44
|
| Rate for Payer: Blue Shield of California EPN |
$81.39
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: InnovAge PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOMN NC08 CSF A-AMIN 82017
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900914733
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Cash Price |
$112.75
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Senior |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC SOM NORCLOZAPINE LEVEL
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900912685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.32
|
| Rate for Payer: EPIC Health Plan Senior |
$6.32
|
| Rate for Payer: Galaxy Health WC |
$13.43
|
| Rate for Payer: Global Benefits Group Commercial |
$9.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Multiplan Commercial |
$11.85
|
| Rate for Payer: Networks By Design Commercial |
$10.27
|
| Rate for Payer: Prime Health Services Commercial |
$13.43
|
|
|
HC SOM NORCLOZAPINE LEVEL
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900912685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Adventist Health Commercial |
$3.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.43
|
| Rate for Payer: Blue Shield of California Commercial |
$9.59
|
| Rate for Payer: Blue Shield of California EPN |
$6.27
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Central Health Plan Commercial |
$12.64
|
| Rate for Payer: Cigna of CA HMO |
$10.11
|
| Rate for Payer: Cigna of CA PPO |
$11.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Senior |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$13.43
|
| Rate for Payer: Global Benefits Group Commercial |
$9.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: InnovAge PACE Commercial |
$30.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$11.85
|
| Rate for Payer: Networks By Design Commercial |
$10.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Riverside University Health System MISP |
$22.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.33
|
| Rate for Payer: United Healthcare All Other HMO |
$16.33
|
| Rate for Payer: United Healthcare HMO Rider |
$16.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM NORDOXEPIN LEVEL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$124.89 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.35
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: InnovAge PACE Commercial |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Riverside University Health System MISP |
$14.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
HC SOM NOROVIRUS AG
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900914127
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$76.48
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM NOROVIRUS AG
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900914127
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC SOM NOROVIRUS RNA
|
Facility
|
IP
|
$245.52
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.10 |
| Max. Negotiated Rate |
$220.97 |
| Rate for Payer: Adventist Health Commercial |
$49.10
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Central Health Plan Commercial |
$196.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.21
|
| Rate for Payer: EPIC Health Plan Senior |
$98.21
|
| Rate for Payer: Galaxy Health WC |
$208.69
|
| Rate for Payer: Global Benefits Group Commercial |
$147.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.10
|
| Rate for Payer: Multiplan Commercial |
$184.14
|
| Rate for Payer: Networks By Design Commercial |
$159.59
|
| Rate for Payer: Prime Health Services Commercial |
$208.69
|
|
|
HC SOM NOROVIRUS RNA
|
Facility
|
OP
|
$245.52
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913809
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$49.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$149.03
|
| Rate for Payer: Blue Shield of California EPN |
$97.47
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Cash Price |
$245.52
|
| Rate for Payer: Central Health Plan Commercial |
$196.42
|
| Rate for Payer: Cigna of CA HMO |
$157.13
|
| Rate for Payer: Cigna of CA PPO |
$181.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$208.69
|
| Rate for Payer: Global Benefits Group Commercial |
$147.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$184.14
|
| Rate for Payer: Networks By Design Commercial |
$159.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$208.69
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM N-TELOPEPTIDE CREATININE URINE
|
Facility
|
OP
|
$5.33
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915361
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.24
|
| Rate for Payer: Blue Shield of California EPN |
$2.12
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: Cigna of CA HMO |
$3.41
|
| Rate for Payer: Cigna of CA PPO |
$3.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM N-TELOPEPTIDE CREATININE URINE
|
Facility
|
IP
|
$5.33
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915361
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Adventist Health Commercial |
$1.07
|
| Rate for Payer: Cash Price |
$5.33
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.13
|
| Rate for Payer: EPIC Health Plan Senior |
$2.13
|
| Rate for Payer: Galaxy Health WC |
$4.53
|
| Rate for Payer: Global Benefits Group Commercial |
$3.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.07
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.46
|
| Rate for Payer: Prime Health Services Commercial |
$4.53
|
|
|
HC SOM N-TELOPEPTIDE URINE
|
Facility
|
IP
|
$19.23
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900911412
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$17.31 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.69
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Multiplan Commercial |
$14.42
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
|
|
HC SOM N-TELOPEPTIDE URINE
|
Facility
|
OP
|
$19.23
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900911412
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$200.46 |
| Rate for Payer: Adventist Health Commercial |
$3.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.68
|
| Rate for Payer: Blue Shield of California Commercial |
$11.67
|
| Rate for Payer: Blue Shield of California EPN |
$7.63
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: Cigna of CA HMO |
$12.31
|
| Rate for Payer: Cigna of CA PPO |
$14.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.22
|
| Rate for Payer: EPIC Health Plan Senior |
$18.68
|
| Rate for Payer: Galaxy Health WC |
$16.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.68
|
| Rate for Payer: InnovAge PACE Commercial |
$28.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.03
|
| Rate for Payer: Multiplan Commercial |
$14.42
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.68
|
| Rate for Payer: Prime Health Services Commercial |
$16.35
|
| Rate for Payer: Prime Health Services Medicare |
$19.80
|
| Rate for Payer: Riverside University Health System MISP |
$20.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.13
|
| Rate for Payer: United Healthcare All Other HMO |
$15.13
|
| Rate for Payer: United Healthcare HMO Rider |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: Vantage Medical Group Senior |
$18.68
|
|
|
HC SOM NUCLEOPHOSMIN MUTAT ANAL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 81310
|
| Hospital Charge Code |
900914001
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 NUCLEOPHOSMIN MUTAT ANAL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 81310
|
| Hospital Charge Code |
900914001
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$404.29 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$246.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.49
|
| Rate for Payer: Blue Shield of California Commercial |
$212.45
|
| Rate for Payer: Blue Shield of California EPN |
$138.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| 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 |
$369.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.80
|
| Rate for Payer: EPIC Health Plan Senior |
$246.52
|
| 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: Heritage Provider Network Commercial/Senior |
$404.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$339.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.52
|
| Rate for Payer: InnovAge PACE Commercial |
$369.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$374.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.34
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$246.52
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$261.31
|
| Rate for Payer: Riverside University Health System MISP |
$271.17
|
| 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 |
$199.68
|
| Rate for Payer: United Healthcare All Other HMO |
$199.68
|
| Rate for Payer: United Healthcare HMO Rider |
$199.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.17
|
| Rate for Payer: Vantage Medical Group Senior |
$246.52
|
|
|
HC SOM OLANZAPINE
|
Facility
|
OP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$105.94 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.50
|
| Rate for Payer: Blue Shield of California Commercial |
$56.94
|
| Rate for Payer: Blue Shield of California EPN |
$37.24
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Central Health Plan Commercial |
$75.04
|
| Rate for Payer: Cigna of CA HMO |
$60.03
|
| Rate for Payer: Cigna of CA PPO |
$69.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$79.73
|
| Rate for Payer: Global Benefits Group Commercial |
$56.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$70.35
|
| Rate for Payer: Networks By Design Commercial |
$60.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$79.73
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM OLANZAPINE
|
Facility
|
IP
|
$93.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$84.42 |
| Rate for Payer: Adventist Health Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$93.80
|
| Rate for Payer: Central Health Plan Commercial |
$75.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.52
|
| Rate for Payer: EPIC Health Plan Senior |
$37.52
|
| Rate for Payer: Galaxy Health WC |
$79.73
|
| Rate for Payer: Global Benefits Group Commercial |
$56.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.76
|
| Rate for Payer: Multiplan Commercial |
$70.35
|
| Rate for Payer: Networks By Design Commercial |
$60.97
|
| Rate for Payer: Prime Health Services Commercial |
$79.73
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
OP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.68
|
| Rate for Payer: Blue Shield of California Commercial |
$13.88
|
| Rate for Payer: Blue Shield of California EPN |
$9.08
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: Cigna of CA HMO |
$14.63
|
| Rate for Payer: Cigna of CA PPO |
$16.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.98
|
| Rate for Payer: EPIC Health Plan Senior |
$27.39
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: InnovAge PACE Commercial |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.70
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.39
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
| Rate for Payer: Prime Health Services Medicare |
$29.03
|
| Rate for Payer: Riverside University Health System MISP |
$30.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$20.57 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.14
|
| Rate for Payer: EPIC Health Plan Senior |
$9.14
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$20.57 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.14
|
| Rate for Payer: EPIC Health Plan Senior |
$9.14
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
OP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.68
|
| Rate for Payer: Blue Shield of California Commercial |
$13.88
|
| Rate for Payer: Blue Shield of California EPN |
$9.08
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: Cigna of CA HMO |
$14.63
|
| Rate for Payer: Cigna of CA PPO |
$16.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.98
|
| Rate for Payer: EPIC Health Plan Senior |
$27.39
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: InnovAge PACE Commercial |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.70
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.39
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
| Rate for Payer: Prime Health Services Medicare |
$29.03
|
| Rate for Payer: Riverside University Health System MISP |
$30.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
