|
HC SOM PHOSPHATIDYL ETHANOL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
900915352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC SOM PHOSPHATIDYL ETHANOL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
900915352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.00
|
| Rate for Payer: Blue Distinction Transplant |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$43.26
|
| Rate for Payer: Blue Shield of California EPN |
$34.02
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Media |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC SOM PHOSPHOLIPID AB IGA
|
Facility
|
OP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$186.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.14
|
| Rate for Payer: Blue Distinction Transplant |
$14.46
|
| Rate for Payer: Blue Shield of California Commercial |
$14.89
|
| Rate for Payer: Blue Shield of California EPN |
$11.71
|
| Rate for Payer: Caremore Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Central Health Plan Commercial |
$19.28
|
| Rate for Payer: Cigna of CA HMO |
$15.42
|
| Rate for Payer: Cigna of CA PPO |
$17.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.18
|
| Rate for Payer: Dignity Health Media |
$25.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$20.48
|
| Rate for Payer: Global Benefits Group Commercial |
$14.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: InnovAge PACE Commercial |
$38.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
| Rate for Payer: Networks By Design Commercial |
$15.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.48
|
| Rate for Payer: Prime Health Services Medicare |
$26.98
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM PHOSPHOLIPID AB IGA
|
Facility
|
IP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$21.69 |
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Central Health Plan Commercial |
$19.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.48
|
| Rate for Payer: Global Benefits Group Commercial |
$14.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
| Rate for Payer: Networks By Design Commercial |
$15.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.48
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
|
IP
|
$79.46
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$71.51 |
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Central Health Plan Commercial |
$63.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.89
|
| Rate for Payer: Multiplan Commercial |
$59.60
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
|
OP
|
$79.46
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$281.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$281.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.08
|
| Rate for Payer: Blue Distinction Transplant |
$47.68
|
| Rate for Payer: Blue Shield of California Commercial |
$49.11
|
| Rate for Payer: Blue Shield of California EPN |
$38.62
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Central Health Plan Commercial |
$63.57
|
| Rate for Payer: Cigna of CA HMO |
$50.85
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.54
|
| Rate for Payer: Dignity Health Media |
$67.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.89
|
| Rate for Payer: Multiplan Commercial |
$59.60
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
| Rate for Payer: Riverside University Health System MISP |
$31.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.54
|
| Rate for Payer: Vantage Medical Group Senior |
$67.54
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Central Health Plan Commercial |
$56.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.22
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Multiplan Commercial |
$52.90
|
| Rate for Payer: Networks By Design Commercial |
$45.85
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$741.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.13
|
| Rate for Payer: Blue Distinction Transplant |
$42.32
|
| Rate for Payer: Blue Shield of California Commercial |
$43.59
|
| Rate for Payer: Blue Shield of California EPN |
$34.28
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Central Health Plan Commercial |
$56.43
|
| Rate for Payer: Cigna of CA HMO |
$45.15
|
| Rate for Payer: Cigna of CA PPO |
$52.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$741.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: InnovAge PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$52.90
|
| Rate for Payer: Networks By Design Commercial |
$45.85
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Riverside University Health System MISP |
$494.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
|
OP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.86
|
| Rate for Payer: Blue Distinction Transplant |
$63.84
|
| Rate for Payer: Blue Shield of California Commercial |
$65.76
|
| Rate for Payer: Blue Shield of California EPN |
$51.71
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Media |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$79.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Riverside University Health System MISP |
$42.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
|
IP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC SOM PKHD1 GENE
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$926.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$838.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$738.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$900.97
|
| Rate for Payer: Blue Distinction Transplant |
$915.00
|
| Rate for Payer: Blue Shield of California Commercial |
$942.45
|
| Rate for Payer: Blue Shield of California EPN |
$741.15
|
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: Cigna of CA HMO |
$976.00
|
| Rate for Payer: Cigna of CA PPO |
$1,128.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Dignity Health Media |
$1,296.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,296.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,143.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$533.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
| Rate for Payer: Riverside University Health System MISP |
$610.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.50
|
| Rate for Payer: United Healthcare All Other HMO |
$762.50
|
| Rate for Payer: United Healthcare HMO Rider |
$762.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,296.25
|
|
|
HC SOM PKHD1 GENE
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Cash Price |
$686.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$58.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.07
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$6.53
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.80
|
| Rate for Payer: Dignity Health Media |
$6.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.53
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.53
|
| Rate for Payer: InnovAge PACE Commercial |
$9.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.92
|
| Rate for Payer: Riverside University Health System MISP |
$7.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6.53
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
OP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$207.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$388.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.80
|
| Rate for Payer: Blue Distinction Transplant |
$153.56
|
| Rate for Payer: Blue Shield of California Commercial |
$158.17
|
| Rate for Payer: Blue Shield of California EPN |
$124.39
|
| Rate for Payer: Caremore Medicare Advantage |
$207.31
|
| Rate for Payer: Cash Price |
$115.17
|
| Rate for Payer: Cash Price |
$115.17
|
| Rate for Payer: Central Health Plan Commercial |
$204.75
|
| Rate for Payer: Cigna of CA HMO |
$163.80
|
| Rate for Payer: Cigna of CA PPO |
$189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.96
|
| Rate for Payer: Dignity Health Media |
$207.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$207.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$207.31
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.35
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$191.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$339.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$342.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.31
|
| Rate for Payer: InnovAge PACE Commercial |
$310.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$277.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$277.80
|
| Rate for Payer: Multiplan Commercial |
$191.96
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
| Rate for Payer: Prime Health Services Medicare |
$219.75
|
| Rate for Payer: Riverside University Health System MISP |
$228.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.92
|
| Rate for Payer: United Healthcare All Other HMO |
$167.92
|
| Rate for Payer: United Healthcare HMO Rider |
$167.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$207.31
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
IP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: Cash Price |
$115.17
|
| Rate for Payer: Central Health Plan Commercial |
$204.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.38
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$191.96
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$74.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.97
|
| Rate for Payer: Blue Distinction Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.58
|
| Rate for Payer: Caremore Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Media |
$8.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: InnovAge PACE Commercial |
$12.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.95
|
| Rate for Payer: Riverside University Health System MISP |
$9.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
|
OP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.53
|
| Rate for Payer: Blue Distinction Transplant |
$12.65
|
| Rate for Payer: Blue Shield of California Commercial |
$13.03
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Caremore Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Central Health Plan Commercial |
$16.86
|
| Rate for Payer: Cigna of CA HMO |
$13.49
|
| Rate for Payer: Cigna of CA PPO |
$15.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.06
|
| Rate for Payer: Dignity Health Media |
$14.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.71
|
| Rate for Payer: Galaxy Health WC |
$17.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.71
|
| Rate for Payer: InnovAge PACE Commercial |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.71
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: Prime Health Services Commercial |
$17.92
|
| Rate for Payer: Prime Health Services Medicare |
$15.59
|
| Rate for Payer: Riverside University Health System MISP |
$16.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
|
HC SOM PORPHYRINS FRAC RND U
|
Facility
|
IP
|
$21.08
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900914687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Cash Price |
$9.49
|
| Rate for Payer: Central Health Plan Commercial |
$16.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.43
|
| Rate for Payer: Galaxy Health WC |
$17.92
|
| Rate for Payer: Global Benefits Group Commercial |
$12.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.22
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Networks By Design Commercial |
$13.70
|
| Rate for Payer: Prime Health Services Commercial |
$17.92
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
|
IP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$10.88 |
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Central Health Plan Commercial |
$9.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.84
|
| Rate for Payer: Galaxy Health WC |
$10.28
|
| Rate for Payer: Global Benefits Group Commercial |
$7.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: Networks By Design Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$10.28
|
|
|
HC SOM PORPHYRINS QN RND U
|
Facility
|
OP
|
$12.09
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900914686
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$74.97 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.97
|
| Rate for Payer: Blue Distinction Transplant |
$7.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7.47
|
| Rate for Payer: Blue Shield of California EPN |
$5.88
|
| Rate for Payer: Caremore Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Cash Price |
$5.44
|
| Rate for Payer: Central Health Plan Commercial |
$9.67
|
| Rate for Payer: Cigna of CA HMO |
$7.74
|
| Rate for Payer: Cigna of CA PPO |
$8.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.66
|
| Rate for Payer: Dignity Health Media |
$8.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.44
|
| Rate for Payer: Galaxy Health WC |
$10.28
|
| Rate for Payer: Global Benefits Group Commercial |
$7.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.44
|
| Rate for Payer: InnovAge PACE Commercial |
$12.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.31
|
| Rate for Payer: Multiplan Commercial |
$9.07
|
| Rate for Payer: Networks By Design Commercial |
$7.86
|
| Rate for Payer: Prime Health Services Commercial |
$10.28
|
| Rate for Payer: Prime Health Services Medicare |
$8.95
|
| Rate for Payer: Riverside University Health System MISP |
$9.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.84
|
| Rate for Payer: United Healthcare All Other HMO |
$6.84
|
| Rate for Payer: United Healthcare HMO Rider |
$6.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.28
|
| Rate for Payer: Vantage Medical Group Senior |
$8.44
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$62.07 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.07
|
| Rate for Payer: Blue Distinction Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Caremore Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Media |
$8.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: InnovAge PACE Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM PORPHYRINS TOTAL PLAS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM PORPHYRINS URINE FRACTIONATED
|
Facility
|
OP
|
$28.59
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
900911511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.53
|
| Rate for Payer: Blue Distinction Transplant |
$17.15
|
| Rate for Payer: Blue Shield of California Commercial |
$17.67
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Caremore Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Central Health Plan Commercial |
$22.87
|
| Rate for Payer: Cigna of CA HMO |
$18.30
|
| Rate for Payer: Cigna of CA PPO |
$21.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.06
|
| Rate for Payer: Dignity Health Media |
$14.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.71
|
| Rate for Payer: Galaxy Health WC |
$24.30
|
| Rate for Payer: Global Benefits Group Commercial |
$17.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.73
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.71
|
| Rate for Payer: InnovAge PACE Commercial |
$22.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.71
|
| Rate for Payer: Multiplan Commercial |
$21.44
|
| Rate for Payer: Networks By Design Commercial |
$18.58
|
| Rate for Payer: Prime Health Services Commercial |
$24.30
|
| Rate for Payer: Prime Health Services Medicare |
$15.59
|
| Rate for Payer: Riverside University Health System MISP |
$16.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.92
|
| Rate for Payer: United Healthcare All Other HMO |
$11.92
|
| Rate for Payer: United Healthcare HMO Rider |
$11.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.18
|
| Rate for Payer: Vantage Medical Group Senior |
$14.71
|
|
