|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM NEUROTENSIN
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC SOM NEUROTENSIN
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: BCBS Transplant Transplant |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$166.86
|
| Rate for Payer: Blue Shield of California EPN |
$131.22
|
| Rate for Payer: Caremore Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$202.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: IEHP medi-cal |
$30.36
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Innovage PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: Riverside University Health MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
IP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
OP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$117.00
|
| Rate for Payer: Blue Shield of California Commercial |
$120.51
|
| Rate for Payer: Blue Shield of California EPN |
$94.77
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Cash Price |
$87.75
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
IP
|
$194.68
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.94 |
| Max. Negotiated Rate |
$175.21 |
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Central Health Plan Commercial |
$155.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.87
|
| Rate for Payer: Galaxy Health WC |
$165.48
|
| Rate for Payer: Global Benefits Group Commercial |
$116.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.94
|
| Rate for Payer: Multiplan Commercial |
$146.01
|
| Rate for Payer: Networks By Design Commercial |
$126.54
|
| Rate for Payer: Prime Health Services Commercial |
$165.48
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
OP
|
$194.68
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$116.81
|
| Rate for Payer: Blue Shield of California Commercial |
$120.31
|
| Rate for Payer: Blue Shield of California EPN |
$94.61
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Cash Price |
$87.61
|
| Rate for Payer: Central Health Plan Commercial |
$155.74
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$144.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$165.48
|
| Rate for Payer: Global Benefits Group Commercial |
$116.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.21
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$146.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.94
|
| 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 |
$146.01
|
| Rate for Payer: Networks By Design Commercial |
$126.54
|
| Rate for Payer: Prime Health Services Commercial |
$165.48
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$116.81
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM NICOTINE
|
Facility
OP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$255.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.51
|
| Rate for Payer: BCBS Transplant Transplant |
$12.21
|
| Rate for Payer: Blue Shield of California Commercial |
$12.58
|
| Rate for Payer: Blue Shield of California EPN |
$9.89
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Central Health Plan Commercial |
$16.28
|
| Rate for Payer: Cigna of CA HMO |
$13.02
|
| Rate for Payer: Cigna of CA PPO |
$15.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.14
|
| Rate for Payer: Galaxy Health WC |
$17.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.32
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.26
|
| Rate for Payer: IEHP medi-cal |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.21
|
| Rate for Payer: Riverside University Health MISP |
$8.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO |
$10.18
|
| Rate for Payer: United Healthcare HMO Rider |
$10.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.30
|
| Rate for Payer: Vantage Medical Group Senior |
$17.30
|
|
|
HC SOM NICOTINE
|
Facility
IP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Central Health Plan Commercial |
$16.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: Galaxy Health WC |
$17.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.30
|
|
|
HC SOM NITROGEN STOOL
|
Facility
OP
|
$388.30
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$349.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$330.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$213.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.41
|
| Rate for Payer: BCBS Transplant Transplant |
$232.98
|
| Rate for Payer: Blue Shield of California Commercial |
$239.97
|
| Rate for Payer: Blue Shield of California EPN |
$188.71
|
| Rate for Payer: Cash Price |
$174.74
|
| Rate for Payer: Central Health Plan Commercial |
$310.64
|
| Rate for Payer: Cigna of CA HMO |
$248.51
|
| Rate for Payer: Cigna of CA PPO |
$287.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$330.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$155.32
|
| Rate for Payer: Galaxy Health WC |
$330.06
|
| Rate for Payer: Global Benefits Group Commercial |
$232.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.47
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$291.22
|
| Rate for Payer: IEHP medi-cal |
$135.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.66
|
| Rate for Payer: Multiplan Commercial |
$291.22
|
| Rate for Payer: Networks By Design Commercial |
$252.40
|
| Rate for Payer: Prime Health Services Commercial |
$330.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$232.98
|
| Rate for Payer: Riverside University Health MISP |
$155.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$194.15
|
| Rate for Payer: United Healthcare All Other HMO |
$194.15
|
| Rate for Payer: United Healthcare HMO Rider |
$194.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.06
|
| Rate for Payer: Vantage Medical Group Senior |
$330.06
|
|
|
HC SOM NITROGEN STOOL
|
Facility
IP
|
$388.30
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$349.47 |
| Rate for Payer: Cash Price |
$174.74
|
| Rate for Payer: Central Health Plan Commercial |
$310.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.32
|
| Rate for Payer: Galaxy Health WC |
$330.06
|
| Rate for Payer: Global Benefits Group Commercial |
$232.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.66
|
| Rate for Payer: Multiplan Commercial |
$291.22
|
| Rate for Payer: Networks By Design Commercial |
$252.40
|
| Rate for Payer: Prime Health Services Commercial |
$330.06
|
|
|
HC SOM NMDCS 86255
|
Facility
OP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$309.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$206.60
|
| Rate for Payer: Blue Shield of California Commercial |
$212.80
|
| Rate for Payer: Blue Shield of California EPN |
$167.34
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$154.95
|
| Rate for Payer: Cash Price |
$154.95
|
| Rate for Payer: Central Health Plan Commercial |
$275.46
|
| Rate for Payer: Cigna of CA HMO |
$220.37
|
| Rate for Payer: Cigna of CA PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$292.68
|
| Rate for Payer: Global Benefits Group Commercial |
$206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$258.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
| Rate for Payer: Networks By Design Commercial |
$223.81
|
| Rate for Payer: Prime Health Services Commercial |
$292.68
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$206.60
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$206.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM NMDCS 86255
|
Facility
IP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$309.90 |
| Rate for Payer: Cash Price |
$154.95
|
| Rate for Payer: Central Health Plan Commercial |
$275.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.73
|
| Rate for Payer: Galaxy Health WC |
$292.68
|
| Rate for Payer: Global Benefits Group Commercial |
$206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$229.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.87
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
| Rate for Payer: Networks By Design Commercial |
$223.81
|
| Rate for Payer: Prime Health Services Commercial |
$292.68
|
|
|
HC SOM NMHIN 83789
|
Facility
OP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$97.47
|
| Rate for Payer: Blue Shield of California Commercial |
$100.39
|
| Rate for Payer: Blue Shield of California EPN |
$78.95
|
| Rate for Payer: Caremore Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Central Health Plan Commercial |
$129.96
|
| Rate for Payer: Cigna of CA HMO |
$103.97
|
| Rate for Payer: Cigna of CA PPO |
$120.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.11
|
| Rate for Payer: Galaxy Health WC |
$138.08
|
| Rate for Payer: Global Benefits Group Commercial |
$97.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: IEHP medi-cal |
$39.78
|
| Rate for Payer: IEHP Medicare Advantage |
$24.11
|
| Rate for Payer: Innovage PACE Commercial |
$36.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
| Rate for Payer: Networks By Design Commercial |
$105.59
|
| Rate for Payer: Prime Health Services Commercial |
$138.08
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$97.47
|
| Rate for Payer: Riverside University Health MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM NMHIN 83789
|
Facility
IP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Cash Price |
$73.10
|
| Rate for Payer: Central Health Plan Commercial |
$129.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.98
|
| Rate for Payer: Galaxy Health WC |
$138.08
|
| Rate for Payer: Global Benefits Group Commercial |
$97.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
| Rate for Payer: Networks By Design Commercial |
$105.59
|
| Rate for Payer: Prime Health Services Commercial |
$138.08
|
|
|
HC SOM NMO EVAL W/REFLEX, SERUM
|
Facility
OP
|
$467.90
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$421.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: BCBS Transplant Transplant |
$280.74
|
| Rate for Payer: Blue Shield of California Commercial |
$289.16
|
| Rate for Payer: Blue Shield of California EPN |
$227.40
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Central Health Plan Commercial |
$374.32
|
| Rate for Payer: Cigna of CA HMO |
$299.46
|
| Rate for Payer: Cigna of CA PPO |
$346.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$397.72
|
| Rate for Payer: Global Benefits Group Commercial |
$280.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$350.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
| Rate for Payer: Networks By Design Commercial |
$304.14
|
| Rate for Payer: Prime Health Services Commercial |
$397.72
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$280.74
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$280.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NMO EVAL W/REFLEX, SERUM
|
Facility
IP
|
$467.90
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912998
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$421.11 |
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Central Health Plan Commercial |
$374.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.16
|
| Rate for Payer: Galaxy Health WC |
$397.72
|
| Rate for Payer: Global Benefits Group Commercial |
$280.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.58
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
| Rate for Payer: Networks By Design Commercial |
$304.14
|
| Rate for Payer: Prime Health Services Commercial |
$397.72
|
|
|
HC SOM NMO-IGG
|
Facility
OP
|
$467.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$421.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.99
|
| Rate for Payer: BCBS Transplant Transplant |
$280.74
|
| Rate for Payer: Blue Shield of California Commercial |
$289.16
|
| Rate for Payer: Blue Shield of California EPN |
$227.40
|
| Rate for Payer: Caremore Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Central Health Plan Commercial |
$374.32
|
| Rate for Payer: Cigna of CA HMO |
$299.46
|
| Rate for Payer: Cigna of CA PPO |
$346.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$397.72
|
| Rate for Payer: Global Benefits Group Commercial |
$280.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$350.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: IEHP medi-cal |
$19.88
|
| Rate for Payer: IEHP Medicare Advantage |
$12.05
|
| Rate for Payer: Innovage PACE Commercial |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
| Rate for Payer: Networks By Design Commercial |
$304.14
|
| Rate for Payer: Prime Health Services Commercial |
$397.72
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$280.74
|
| Rate for Payer: Riverside University Health MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$280.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.76
|
| Rate for Payer: United Healthcare All Other HMO |
$9.76
|
| Rate for Payer: United Healthcare HMO Rider |
$9.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM NMO-IGG
|
Facility
IP
|
$467.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$421.11 |
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Central Health Plan Commercial |
$374.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.16
|
| Rate for Payer: Galaxy Health WC |
$397.72
|
| Rate for Payer: Global Benefits Group Commercial |
$280.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$421.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.58
|
| Rate for Payer: Multiplan Commercial |
$350.92
|
| Rate for Payer: Networks By Design Commercial |
$304.14
|
| Rate for Payer: Prime Health Services Commercial |
$397.72
|
|
|
HC SOMN NC05 CSF P-5-P 82491
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914867
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$166.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$114.33
|
| Rate for Payer: Blue Shield of California EPN |
$89.91
|
| Rate for Payer: Caremore Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Central Health Plan Commercial |
$148.00
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$138.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: IEHP medi-cal |
$39.75
|
| Rate for Payer: IEHP Medicare Advantage |
$24.09
|
| Rate for Payer: Innovage PACE Commercial |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: Riverside University Health MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC 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: Cash Price |
$83.25
|
| Rate for Payer: Central Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$123.40
|
| 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
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: Cash Price |
$92.25
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: AlphaCare 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 |
$148.99
|
| Rate for Payer: BCBS Transplant Transplant |
$123.00
|
| Rate for Payer: Blue Shield of California Commercial |
$126.69
|
| Rate for Payer: Blue Shield of California EPN |
$99.63
|
| Rate for Payer: Caremore Medicare Advantage |
$16.87
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Cash Price |
$92.25
|
| 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: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$153.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: IEHP medi-cal |
$27.84
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: Riverside University Health 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: 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: Cash Price |
$92.25
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
