|
HC SOM QUANTIFERON TB GOLD
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
900912882
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM RIBOSOMAL P AB
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911367
|
|
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 RIBOSOMAL P AB
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911367
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.60
|
| 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 |
$11.53
|
| 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 |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| 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 |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| 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 |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| 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 |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM RISTOCETIN-WILLEBRAND FACTOR
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
900911282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM RISTOCETIN-WILLEBRAND FACTOR
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
900911282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$203.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Distinction Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.72
|
| Rate for Payer: Blue Shield of California EPN |
$19.44
|
| Rate for Payer: Caremore Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Media |
$22.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: InnovAge PACE Commercial |
$34.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$24.32
|
| Rate for Payer: Riverside University Health System MISP |
$25.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.58
|
| Rate for Payer: United Healthcare All Other HMO |
$18.58
|
| Rate for Payer: United Healthcare HMO Rider |
$18.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
OP
|
$169.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$152.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$101.58
|
| Rate for Payer: Blue Shield of California Commercial |
$104.63
|
| Rate for Payer: Blue Shield of California EPN |
$82.28
|
| Rate for Payer: Caremore Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Central Health Plan Commercial |
$135.44
|
| Rate for Payer: Cigna of CA HMO |
$108.35
|
| Rate for Payer: Cigna of CA PPO |
$125.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Media |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.25
|
| Rate for Payer: Galaxy Health WC |
$143.90
|
| Rate for Payer: Global Benefits Group Commercial |
$101.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.37
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: InnovAge PACE Commercial |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$126.98
|
| Rate for Payer: Networks By Design Commercial |
$110.04
|
| Rate for Payer: Prime Health Services Commercial |
$143.90
|
| Rate for Payer: Prime Health Services Medicare |
$12.98
|
| Rate for Payer: Riverside University Health System MISP |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$11.12
|
| Rate for Payer: Blue Shield of California Commercial |
$11.46
|
| Rate for Payer: Blue Shield of California EPN |
$9.01
|
| Rate for Payer: Caremore Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: Cigna of CA HMO |
$11.87
|
| Rate for Payer: Cigna of CA PPO |
$13.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Media |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.25
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: InnovAge PACE Commercial |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
| Rate for Payer: Prime Health Services Medicare |
$12.98
|
| Rate for Payer: Riverside University Health System MISP |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913806
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.76
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$15.76
|
|
|
HC SOM SACCHAROMY CEREVI AB, IGA
|
Facility
|
IP
|
$169.30
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900913805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$152.37 |
| Rate for Payer: Cash Price |
$76.19
|
| Rate for Payer: Central Health Plan Commercial |
$135.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.72
|
| Rate for Payer: Galaxy Health WC |
$143.90
|
| Rate for Payer: Global Benefits Group Commercial |
$101.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$126.98
|
| Rate for Payer: Networks By Design Commercial |
$110.04
|
| Rate for Payer: Prime Health Services Commercial |
$143.90
|
|
|
HC SOM SAL 86606
|
Facility
|
OP
|
$21.57
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$133.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.58
|
| Rate for Payer: Blue Distinction Transplant |
$12.94
|
| Rate for Payer: Blue Shield of California Commercial |
$13.33
|
| Rate for Payer: Blue Shield of California EPN |
$10.48
|
| Rate for Payer: Caremore Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Central Health Plan Commercial |
$17.26
|
| Rate for Payer: Cigna of CA HMO |
$13.80
|
| Rate for Payer: Cigna of CA PPO |
$15.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Media |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$18.33
|
| Rate for Payer: Global Benefits Group Commercial |
$12.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.41
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: InnovAge PACE Commercial |
$22.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$16.18
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Prime Health Services Commercial |
$18.33
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Riverside University Health System MISP |
$16.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM SAL 86606
|
Facility
|
IP
|
$21.57
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$19.41 |
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Central Health Plan Commercial |
$17.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.63
|
| Rate for Payer: Galaxy Health WC |
$18.33
|
| Rate for Payer: Global Benefits Group Commercial |
$12.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.31
|
| Rate for Payer: Multiplan Commercial |
$16.18
|
| Rate for Payer: Networks By Design Commercial |
$14.02
|
| Rate for Payer: Prime Health Services Commercial |
$18.33
|
|
|
HC SOM SAL 86671A
|
Facility
|
IP
|
$17.55
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
|
|
HC SOM SAL 86671A
|
Facility
|
OP
|
$17.55
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914749
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$10.53
|
| Rate for Payer: Blue Shield of California Commercial |
$10.85
|
| Rate for Payer: Blue Shield of California EPN |
$8.53
|
| Rate for Payer: Caremore Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.04
|
| Rate for Payer: Cigna of CA HMO |
$11.23
|
| Rate for Payer: Cigna of CA PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Media |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.25
|
| Rate for Payer: Galaxy Health WC |
$14.92
|
| Rate for Payer: Global Benefits Group Commercial |
$10.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: InnovAge PACE Commercial |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.16
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.92
|
| Rate for Payer: Prime Health Services Medicare |
$12.98
|
| Rate for Payer: Riverside University Health System MISP |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SAL 86671B
|
Facility
|
OP
|
$17.56
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$10.54
|
| Rate for Payer: Blue Shield of California Commercial |
$10.85
|
| Rate for Payer: Blue Shield of California EPN |
$8.53
|
| Rate for Payer: Caremore Medicare Advantage |
$12.25
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.05
|
| Rate for Payer: Cigna of CA HMO |
$11.24
|
| Rate for Payer: Cigna of CA PPO |
$12.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.38
|
| Rate for Payer: Dignity Health Media |
$12.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.25
|
| Rate for Payer: Galaxy Health WC |
$14.93
|
| Rate for Payer: Global Benefits Group Commercial |
$10.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.25
|
| Rate for Payer: InnovAge PACE Commercial |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.42
|
| Rate for Payer: Multiplan Commercial |
$13.17
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.93
|
| Rate for Payer: Prime Health Services Medicare |
$12.98
|
| Rate for Payer: Riverside University Health System MISP |
$13.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.93
|
| Rate for Payer: United Healthcare All Other HMO |
$9.93
|
| Rate for Payer: United Healthcare HMO Rider |
$9.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.48
|
| Rate for Payer: Vantage Medical Group Senior |
$12.25
|
|
|
HC SOM SAL 86671B
|
Facility
|
IP
|
$17.56
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
900914750
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.02
|
| Rate for Payer: Galaxy Health WC |
$14.93
|
| Rate for Payer: Global Benefits Group Commercial |
$10.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.17
|
| Rate for Payer: Networks By Design Commercial |
$11.41
|
| Rate for Payer: Prime Health Services Commercial |
$14.93
|
|
|
HC SOM SARS-COV-2 IGG
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900915349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.20
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
|
|
HC SOM SARS-COV-2 IGG
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900915349
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$262.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$42.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.86
|
| Rate for Payer: Blue Distinction Transplant |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$26.57
|
| Rate for Payer: Blue Shield of California EPN |
$20.90
|
| Rate for Payer: Caremore Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Central Health Plan Commercial |
$34.40
|
| Rate for Payer: Cigna of CA HMO |
$27.52
|
| Rate for Payer: Cigna of CA PPO |
$31.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.20
|
| Rate for Payer: Dignity Health Media |
$42.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.13
|
| Rate for Payer: Galaxy Health WC |
$36.55
|
| Rate for Payer: Global Benefits Group Commercial |
$25.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$69.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.13
|
| Rate for Payer: InnovAge PACE Commercial |
$63.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$32.25
|
| Rate for Payer: Networks By Design Commercial |
$27.95
|
| Rate for Payer: Prime Health Services Commercial |
$36.55
|
| Rate for Payer: Prime Health Services Medicare |
$44.66
|
| Rate for Payer: Riverside University Health System MISP |
$46.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.13
|
| Rate for Payer: United Healthcare All Other HMO |
$34.13
|
| Rate for Payer: United Healthcare HMO Rider |
$34.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Vantage Medical Group Senior |
$42.13
|
|
|
HC SOM SCHISTOSOMIASIS AB IGG
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.49
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Media |
$13.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.01
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: InnovAge PACE Commercial |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Riverside University Health System MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM SCHISTOSOMIASIS AB IGG
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911335
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
IP
|
$228.60
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$205.74 |
| Rate for Payer: Cash Price |
$102.87
|
| Rate for Payer: Central Health Plan Commercial |
$182.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.44
|
| Rate for Payer: Galaxy Health WC |
$194.31
|
| Rate for Payer: Global Benefits Group Commercial |
$137.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.72
|
| Rate for Payer: Multiplan Commercial |
$171.45
|
| Rate for Payer: Networks By Design Commercial |
$148.59
|
| Rate for Payer: Prime Health Services Commercial |
$194.31
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
OP
|
$228.60
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$205.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.50
|
| Rate for Payer: Blue Distinction Transplant |
$137.16
|
| Rate for Payer: Blue Shield of California Commercial |
$141.27
|
| Rate for Payer: Blue Shield of California EPN |
$111.10
|
| Rate for Payer: Cash Price |
$102.87
|
| Rate for Payer: Cash Price |
$102.87
|
| Rate for Payer: Central Health Plan Commercial |
$182.88
|
| Rate for Payer: Cigna of CA HMO |
$146.30
|
| Rate for Payer: Cigna of CA PPO |
$169.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.31
|
| Rate for Payer: Dignity Health Media |
$194.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.44
|
| Rate for Payer: Galaxy Health WC |
$194.31
|
| Rate for Payer: Global Benefits Group Commercial |
$137.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.72
|
| Rate for Payer: Multiplan Commercial |
$171.45
|
| Rate for Payer: Networks By Design Commercial |
$148.59
|
| Rate for Payer: Prime Health Services Commercial |
$194.31
|
| Rate for Payer: Riverside University Health System MISP |
$91.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.30
|
| Rate for Payer: United Healthcare All Other HMO |
$114.30
|
| Rate for Payer: United Healthcare HMO Rider |
$114.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.31
|
| Rate for Payer: Vantage Medical Group Senior |
$194.31
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
OP
|
$25.62
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$226.59 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.59
|
| Rate for Payer: Blue Distinction Transplant |
$15.37
|
| Rate for Payer: Blue Shield of California Commercial |
$15.83
|
| Rate for Payer: Blue Shield of California EPN |
$12.45
|
| Rate for Payer: Caremore Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Central Health Plan Commercial |
$20.50
|
| Rate for Payer: Cigna of CA HMO |
$16.40
|
| Rate for Payer: Cigna of CA PPO |
$18.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.30
|
| Rate for Payer: Dignity Health Media |
$25.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.53
|
| Rate for Payer: Galaxy Health WC |
$21.78
|
| Rate for Payer: Global Benefits Group Commercial |
$15.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.53
|
| Rate for Payer: InnovAge PACE Commercial |
$38.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$19.22
|
| Rate for Payer: Networks By Design Commercial |
$16.65
|
| Rate for Payer: Prime Health Services Commercial |
$21.78
|
| Rate for Payer: Prime Health Services Medicare |
$27.06
|
| Rate for Payer: Riverside University Health System MISP |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.68
|
| Rate for Payer: United Healthcare All Other HMO |
$20.68
|
| Rate for Payer: United Healthcare HMO Rider |
$20.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$25.53
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
IP
|
$25.62
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Cash Price |
$11.53
|
| Rate for Payer: Central Health Plan Commercial |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.25
|
| Rate for Payer: Galaxy Health WC |
$21.78
|
| Rate for Payer: Global Benefits Group Commercial |
$15.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: Multiplan Commercial |
$19.22
|
| Rate for Payer: Networks By Design Commercial |
$16.65
|
| Rate for Payer: Prime Health Services Commercial |
$21.78
|
|
|
HC SOM SEROTONIN BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
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 SEROTONIN BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$274.86 |
| Rate for Payer: Adventist Health Medi-Cal |
$30.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$225.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.86
|
| 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 |
$30.98
|
| 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 |
$46.47
|
| Rate for Payer: Dignity Health Media |
$30.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$30.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.98
|
| 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 |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: InnovAge PACE Commercial |
$46.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.51
|
| 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 |
$32.84
|
| Rate for Payer: Riverside University Health System MISP |
$34.08
|
| 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 |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
