|
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
|
|
|
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 |
$131.61 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.75
|
| Rate for Payer: BCBS Transplant Transplant |
$9.48
|
| Rate for Payer: Blue Shield of California Commercial |
$9.76
|
| Rate for Payer: Blue Shield of California EPN |
$7.68
|
| Rate for Payer: Caremore Medicare Advantage |
$20.15
|
| Rate for Payer: Cash Price |
$7.11
|
| Rate for Payer: Cash Price |
$7.11
|
| 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 |
$30.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.15
|
| Rate for Payer: Galaxy Health WC |
$13.43
|
| Rate for Payer: Global Benefits Group Commercial |
$9.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: IEHP medi-cal |
$33.25
|
| Rate for Payer: IEHP Medicare Advantage |
$20.15
|
| Rate for Payer: Innovage PACE Commercial |
$30.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.54
|
| 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: Prime Health Services Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.48
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$30.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM 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: Cash Price |
$7.11
|
| Rate for Payer: Central Health Plan Commercial |
$12.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$15.75
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$0.06 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.34
|
| Rate for Payer: BCBS Transplant Transplant |
$21.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.63
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| 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: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$26.25
|
| Rate for Payer: IEHP medi-cal |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$29.75
|
| Rate for Payer: Vantage Medical Group Senior |
$29.75
|
|
|
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: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare 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 |
$79.75
|
| Rate for Payer: BCBS Transplant Transplant |
$75.60
|
| Rate for Payer: Blue Shield of California Commercial |
$77.87
|
| Rate for Payer: Blue Shield of California EPN |
$61.24
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| 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: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$94.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: IEHP medi-cal |
$19.77
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$110.48
|
| Rate for Payer: Central Health Plan Commercial |
$196.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$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 |
$147.31
|
| Rate for Payer: Blue Shield of California Commercial |
$151.73
|
| Rate for Payer: Blue Shield of California EPN |
$119.32
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$110.48
|
| Rate for Payer: Cash Price |
$110.48
|
| 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 |
$52.64
|
| 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 |
$208.69
|
| Rate for Payer: Global Benefits Group Commercial |
$147.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$184.14
|
| 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 |
$163.76
|
| 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: Prime Health Services Commercial |
$208.69
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$147.31
|
| Rate for Payer: Riverside University Health 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: 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 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 |
$45.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: AlphaCare 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 |
$45.88
|
| Rate for Payer: BCBS Transplant Transplant |
$3.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3.29
|
| Rate for Payer: Blue Shield of California EPN |
$2.59
|
| Rate for Payer: Caremore Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| 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: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$4.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: IEHP medi-cal |
$8.55
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.20
|
| Rate for Payer: Riverside University Health 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: 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: Cash Price |
$2.40
|
| Rate for Payer: Central Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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, CROSS LINKED
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC SOM N-TELOPEPTIDE, CROSS LINKED
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
900912632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$244.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: AlphaCare 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 |
$244.52
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$55.62
|
| Rate for Payer: Blue Shield of California EPN |
$43.74
|
| Rate for Payer: Caremore Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.68
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.64
|
| Rate for Payer: IEHP medi-cal |
$30.82
|
| Rate for Payer: IEHP Medicare Advantage |
$18.68
|
| Rate for Payer: Innovage PACE Commercial |
$28.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| 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 |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Medicare |
$19.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: Riverside University Health MISP |
$20.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| 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: 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 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 |
$244.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.55
|
| Rate for Payer: AlphaCare 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 |
$244.52
|
| Rate for Payer: BCBS Transplant Transplant |
$11.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11.88
|
| Rate for Payer: Blue Shield of California EPN |
$9.35
|
| Rate for Payer: Caremore Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$8.65
|
| Rate for Payer: Cash Price |
$8.65
|
| 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: EPIC Health Plan Commercial |
$25.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$14.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.64
|
| Rate for Payer: IEHP medi-cal |
$30.82
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$16.35
|
| Rate for Payer: Prime Health Services Medicare |
$19.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.54
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$8.65
|
| Rate for Payer: Central Health Plan Commercial |
$15.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 NUCLEOPHOSMIN MUTAT ANAL
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT 81310
|
| Hospital Charge Code |
900914001
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$406.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$246.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$369.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$271.17
|
| Rate for Payer: AlphaCare 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 |
$333.47
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$216.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Caremore Medicare Advantage |
$246.52
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$332.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$246.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$404.29
|
| Rate for Payer: IEHP medi-cal |
$406.76
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$261.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM 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 |
$129.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare 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 |
$129.22
|
| Rate for Payer: BCBS Transplant Transplant |
$56.28
|
| Rate for Payer: Blue Shield of California Commercial |
$57.97
|
| Rate for Payer: Blue Shield of California EPN |
$45.59
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$42.21
|
| Rate for Payer: Cash Price |
$42.21
|
| 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: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$70.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: IEHP medi-cal |
$30.76
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$79.73
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$56.28
|
| Rate for Payer: Riverside University Health 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: 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: Cash Price |
$42.21
|
| Rate for Payer: Central Health Plan Commercial |
$75.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
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: Cash Price |
$10.29
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$178.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: AlphaCare 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 |
$178.38
|
| Rate for Payer: BCBS Transplant Transplant |
$13.72
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Caremore Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: Cash Price |
$10.29
|
| 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 |
$41.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$17.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.92
|
| Rate for Payer: IEHP medi-cal |
$45.19
|
| Rate for Payer: IEHP Medicare Advantage |
$27.39
|
| Rate for Payer: Innovage PACE Commercial |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| 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: Prime Health Services Commercial |
$19.43
|
| Rate for Payer: Prime Health Services Medicare |
$29.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.72
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$41.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
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 |
$178.38 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: AlphaCare 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 |
$178.38
|
| Rate for Payer: BCBS Transplant Transplant |
$13.72
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$11.11
|
| Rate for Payer: Caremore Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$10.29
|
| Rate for Payer: Cash Price |
$10.29
|
| 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 |
$41.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.98
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$17.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.92
|
| Rate for Payer: IEHP medi-cal |
$45.19
|
| Rate for Payer: IEHP Medicare Advantage |
$27.39
|
| Rate for Payer: Innovage PACE Commercial |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.25
|
| 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: Prime Health Services Commercial |
$19.43
|
| Rate for Payer: Prime Health Services Medicare |
$29.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.72
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$41.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
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: Cash Price |
$10.29
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 OPATU DRUG SCRN OXYCDN
|
Facility
IP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
OP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.60
|
| Rate for Payer: BCBS Transplant Transplant |
$8.36
|
| Rate for Payer: Blue Shield of California Commercial |
$8.61
|
| Rate for Payer: Blue Shield of California EPN |
$6.77
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Cash Price |
$6.27
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$8.92
|
| Rate for Payer: Cigna of CA PPO |
$10.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.45
|
| Rate for Payer: IEHP medi-cal |
$4.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: Riverside University Health MISP |
$5.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6.96
|
| Rate for Payer: United Healthcare HMO Rider |
$6.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
