|
HC SOM STREPTOCOCCAL ABS, SNTISTREP-O
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
900912820
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$64.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.76
|
| Rate for Payer: BCBS Transplant Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Caremore Medicare Advantage |
$7.30
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.86
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.30
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.97
|
| Rate for Payer: IEHP medi-cal |
$12.04
|
| Rate for Payer: IEHP Medicare Advantage |
$7.30
|
| Rate for Payer: Innovage PACE Commercial |
$10.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.78
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$7.74
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: Riverside University Health MISP |
$8.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.03
|
| Rate for Payer: Vantage Medical Group Senior |
$7.30
|
|
|
HC SOM STRONGYLOIDES AB
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900915435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC SOM STRONGYLOIDES AB
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900915435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.60 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California EPN |
$18.47
|
| Rate for Payer: Caremore Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| 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 |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: IEHP medi-cal |
$21.47
|
| Rate for Payer: IEHP Medicare Advantage |
$13.01
|
| Rate for Payer: Innovage PACE Commercial |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| 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 |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: Riverside University Health MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| 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 SULFA DRUGS
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$129.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.22
|
| Rate for Payer: BCBS Transplant Transplant |
$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 |
$18.64
|
| 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 |
$27.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$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 Transplant Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: IEHP medi-cal |
$30.76
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Innovage PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$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 |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: Riverside University Health MISP |
$20.50
|
| 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 |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SULFA DRUGS
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911100
|
|
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: 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 SULFHEMOGLOBIN
|
Facility
OP
|
$117.04
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900915430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$105.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.68
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.36
|
| Rate for Payer: BCBS Transplant Transplant |
$70.22
|
| Rate for Payer: Blue Shield of California Commercial |
$72.33
|
| Rate for Payer: Blue Shield of California EPN |
$56.88
|
| Rate for Payer: Caremore Medicare Advantage |
$8.80
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Central Health Plan Commercial |
$93.63
|
| Rate for Payer: Cigna of CA HMO |
$74.91
|
| Rate for Payer: Cigna of CA PPO |
$86.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$99.48
|
| Rate for Payer: Global Benefits Group Commercial |
$70.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.34
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$87.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.43
|
| Rate for Payer: IEHP medi-cal |
$14.52
|
| Rate for Payer: IEHP Medicare Advantage |
$8.80
|
| Rate for Payer: Innovage PACE Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$87.78
|
| Rate for Payer: Networks By Design Commercial |
$76.08
|
| Rate for Payer: Prime Health Services Commercial |
$99.48
|
| Rate for Payer: Prime Health Services Medicare |
$9.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$70.22
|
| Rate for Payer: Riverside University Health MISP |
$9.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.13
|
| Rate for Payer: United Healthcare All Other HMO |
$7.13
|
| Rate for Payer: United Healthcare HMO Rider |
$7.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.68
|
| Rate for Payer: Vantage Medical Group Senior |
$8.80
|
|
|
HC SOM SULFHEMOGLOBIN
|
Facility
IP
|
$117.04
|
|
|
Service Code
|
CPT 83060
|
| Hospital Charge Code |
900915430
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$105.34 |
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Central Health Plan Commercial |
$93.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.82
|
| Rate for Payer: Galaxy Health WC |
$99.48
|
| Rate for Payer: Global Benefits Group Commercial |
$70.22
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.41
|
| Rate for Payer: Multiplan Commercial |
$87.78
|
| Rate for Payer: Networks By Design Commercial |
$76.08
|
| Rate for Payer: Prime Health Services Commercial |
$99.48
|
|
|
HC SOM TAPENTADOL URINE
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$172.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.29
|
| Rate for Payer: BCBS Transplant 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: 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 |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$30.00
|
| Rate for Payer: IEHP medi-cal |
$14.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: Riverside University Health MISP |
$16.00
|
| 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 |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC SOM TAPENTADOL URINE
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT 80372
|
| Hospital Charge Code |
900914715
|
|
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: 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 TCP 86359
|
Facility
OP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$335.32 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$274.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.32
|
| Rate for Payer: BCBS Transplant Transplant |
$69.21
|
| Rate for Payer: Blue Shield of California Commercial |
$71.29
|
| Rate for Payer: Blue Shield of California EPN |
$56.06
|
| Rate for Payer: Caremore Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$51.91
|
| Rate for Payer: Cash Price |
$51.91
|
| Rate for Payer: Central Health Plan Commercial |
$92.28
|
| Rate for Payer: Cigna of CA HMO |
$73.82
|
| Rate for Payer: Cigna of CA PPO |
$85.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$98.05
|
| Rate for Payer: Global Benefits Group Commercial |
$69.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$86.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: IEHP medi-cal |
$62.25
|
| Rate for Payer: IEHP Medicare Advantage |
$37.73
|
| Rate for Payer: Innovage PACE Commercial |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$86.51
|
| Rate for Payer: Networks By Design Commercial |
$74.98
|
| Rate for Payer: Prime Health Services Commercial |
$98.05
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$69.21
|
| Rate for Payer: Riverside University Health MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM TCP 86359
|
Facility
IP
|
$115.35
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
900914880
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$103.82 |
| Rate for Payer: Cash Price |
$51.91
|
| Rate for Payer: Central Health Plan Commercial |
$92.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.14
|
| Rate for Payer: Galaxy Health WC |
$98.05
|
| Rate for Payer: Global Benefits Group Commercial |
$69.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$86.51
|
| Rate for Payer: Networks By Design Commercial |
$74.98
|
| Rate for Payer: Prime Health Services Commercial |
$98.05
|
|
|
HC SOM TCP 86361
|
Facility
IP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$73.68 |
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Central Health Plan Commercial |
$65.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.75
|
| Rate for Payer: Galaxy Health WC |
$69.59
|
| Rate for Payer: Global Benefits Group Commercial |
$49.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.37
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
| Rate for Payer: Networks By Design Commercial |
$53.22
|
| Rate for Payer: Prime Health Services Commercial |
$69.59
|
|
|
HC SOM TCP 86361
|
Facility
OP
|
$81.87
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
900914881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$238.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.96
|
| Rate for Payer: BCBS Transplant Transplant |
$49.12
|
| Rate for Payer: Blue Shield of California Commercial |
$50.60
|
| Rate for Payer: Blue Shield of California EPN |
$39.79
|
| Rate for Payer: Caremore Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Cash Price |
$36.84
|
| Rate for Payer: Central Health Plan Commercial |
$65.50
|
| Rate for Payer: Cigna of CA HMO |
$52.40
|
| Rate for Payer: Cigna of CA PPO |
$60.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$69.59
|
| Rate for Payer: Global Benefits Group Commercial |
$49.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: IEHP medi-cal |
$44.19
|
| Rate for Payer: IEHP Medicare Advantage |
$26.78
|
| Rate for Payer: Innovage PACE Commercial |
$40.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$61.40
|
| Rate for Payer: Networks By Design Commercial |
$53.22
|
| Rate for Payer: Prime Health Services Commercial |
$69.59
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.12
|
| Rate for Payer: Riverside University Health MISP |
$29.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC SOM TCP 88184
|
Facility
OP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$39.88 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$119.63
|
| Rate for Payer: Blue Shield of California Commercial |
$123.22
|
| Rate for Payer: Blue Shield of California EPN |
$96.90
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Central Health Plan Commercial |
$159.50
|
| Rate for Payer: Cigna of CA HMO |
$127.60
|
| Rate for Payer: Cigna of CA PPO |
$147.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| 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 |
$169.47
|
| Rate for Payer: Global Benefits Group Commercial |
$119.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.44
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$149.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: IEHP medi-cal |
$741.03
|
| Rate for Payer: IEHP Medicare Advantage |
$449.11
|
| Rate for Payer: Innovage PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.88
|
| 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 |
$149.54
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.47
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$119.63
|
| Rate for Payer: Riverside University Health MISP |
$494.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.63
|
| 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 TCP 88184
|
Facility
IP
|
$199.38
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914882
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$179.44 |
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Central Health Plan Commercial |
$159.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.75
|
| Rate for Payer: Galaxy Health WC |
$169.47
|
| Rate for Payer: Global Benefits Group Commercial |
$119.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$179.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.88
|
| Rate for Payer: Multiplan Commercial |
$149.54
|
| Rate for Payer: Networks By Design Commercial |
$129.60
|
| Rate for Payer: Prime Health Services Commercial |
$169.47
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
IP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$8.05 |
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Central Health Plan Commercial |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.58
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$6.70
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
|
|
HC SOM TESTOSTERONE FREE
|
Facility
OP
|
$8.94
|
|
|
Service Code
|
CPT 84402
|
| Hospital Charge Code |
900911131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$230.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$186.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$189.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.78
|
| Rate for Payer: BCBS Transplant Transplant |
$5.36
|
| Rate for Payer: Blue Shield of California Commercial |
$5.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.34
|
| Rate for Payer: Caremore Medicare Advantage |
$25.47
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Central Health Plan Commercial |
$7.15
|
| Rate for Payer: Cigna of CA HMO |
$5.72
|
| Rate for Payer: Cigna of CA PPO |
$6.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.47
|
| Rate for Payer: Galaxy Health WC |
$7.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.77
|
| Rate for Payer: IEHP medi-cal |
$42.03
|
| Rate for Payer: IEHP Medicare Advantage |
$25.47
|
| Rate for Payer: Innovage PACE Commercial |
$38.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.13
|
| Rate for Payer: Multiplan Commercial |
$6.70
|
| Rate for Payer: Networks By Design Commercial |
$5.81
|
| Rate for Payer: Prime Health Services Commercial |
$7.60
|
| Rate for Payer: Prime Health Services Medicare |
$27.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.36
|
| Rate for Payer: Riverside University Health MISP |
$28.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.63
|
| Rate for Payer: United Healthcare All Other HMO |
$20.63
|
| Rate for Payer: United Healthcare HMO Rider |
$20.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.02
|
| Rate for Payer: Vantage Medical Group Senior |
$25.47
|
|
|
HC SOM TESTOSTERONE TOTAL
|
Facility
OP
|
$9.06
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900915375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$229.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.04
|
| Rate for Payer: BCBS Transplant Transplant |
$5.44
|
| Rate for Payer: Blue Shield of California Commercial |
$5.60
|
| Rate for Payer: Blue Shield of California EPN |
$4.40
|
| Rate for Payer: Caremore Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Central Health Plan Commercial |
$7.25
|
| Rate for Payer: Cigna of CA HMO |
$5.80
|
| Rate for Payer: Cigna of CA PPO |
$6.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$7.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.15
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: IEHP medi-cal |
$42.59
|
| Rate for Payer: IEHP Medicare Advantage |
$25.81
|
| Rate for Payer: Innovage PACE Commercial |
$38.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$6.80
|
| Rate for Payer: Networks By Design Commercial |
$5.89
|
| Rate for Payer: Prime Health Services Commercial |
$7.70
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.44
|
| Rate for Payer: Riverside University Health MISP |
$28.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC SOM TESTOSTERONE TOTAL
|
Facility
IP
|
$9.06
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900915375
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Central Health Plan Commercial |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.62
|
| Rate for Payer: Galaxy Health WC |
$7.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$6.80
|
| Rate for Payer: Networks By Design Commercial |
$5.89
|
| Rate for Payer: Prime Health Services Commercial |
$7.70
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
IP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$18.38 |
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Central Health Plan Commercial |
$16.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$17.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$15.32
|
| Rate for Payer: Networks By Design Commercial |
$13.27
|
| Rate for Payer: Prime Health Services Commercial |
$17.36
|
|
|
HC SOM TETANUS ANTITOXOID (ELISA)
|
Facility
OP
|
$20.42
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$133.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.04
|
| Rate for Payer: BCBS Transplant Transplant |
$12.25
|
| Rate for Payer: Blue Shield of California Commercial |
$12.62
|
| Rate for Payer: Blue Shield of California EPN |
$9.92
|
| Rate for Payer: Caremore Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Central Health Plan Commercial |
$16.34
|
| Rate for Payer: Cigna of CA HMO |
$13.07
|
| Rate for Payer: Cigna of CA PPO |
$15.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$17.36
|
| Rate for Payer: Global Benefits Group Commercial |
$12.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: IEHP medi-cal |
$24.73
|
| Rate for Payer: IEHP Medicare Advantage |
$14.99
|
| Rate for Payer: Innovage PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$15.32
|
| Rate for Payer: Networks By Design Commercial |
$13.27
|
| Rate for Payer: Prime Health Services Commercial |
$17.36
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.25
|
| Rate for Payer: Riverside University Health MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
OP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.01 |
| Max. Negotiated Rate |
$1,327.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.96
|
| Rate for Payer: BCBS Transplant Transplant |
$817.50
|
| Rate for Payer: Blue Shield of California Commercial |
$842.02
|
| Rate for Payer: Blue Shield of California EPN |
$662.18
|
| Rate for Payer: Caremore Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$613.13
|
| Rate for Payer: Cash Price |
$613.13
|
| Rate for Payer: Central Health Plan Commercial |
$1,090.00
|
| Rate for Payer: Cigna of CA HMO |
$872.00
|
| Rate for Payer: Cigna of CA PPO |
$1,008.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$1,158.12
|
| Rate for Payer: Global Benefits Group Commercial |
$817.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,226.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,021.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: IEHP medi-cal |
$305.58
|
| Rate for Payer: IEHP Medicare Advantage |
$185.20
|
| Rate for Payer: Innovage PACE Commercial |
$277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$908.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
| Rate for Payer: Networks By Design Commercial |
$885.62
|
| Rate for Payer: Prime Health Services Commercial |
$1,158.12
|
| Rate for Payer: Prime Health Services Medicare |
$196.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$817.50
|
| Rate for Payer: Riverside University Health MISP |
$203.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$817.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$817.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOM TGFBR2 FULL SEQUENCE
|
Facility
IP
|
$1,362.50
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914669
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$272.50 |
| Max. Negotiated Rate |
$1,226.25 |
| Rate for Payer: Cash Price |
$613.13
|
| Rate for Payer: Central Health Plan Commercial |
$1,090.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$545.00
|
| Rate for Payer: Galaxy Health WC |
$1,158.12
|
| Rate for Payer: Global Benefits Group Commercial |
$817.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,226.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$908.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.50
|
| Rate for Payer: Multiplan Commercial |
$1,021.88
|
| Rate for Payer: Networks By Design Commercial |
$885.62
|
| Rate for Payer: Prime Health Services Commercial |
$1,158.12
|
|
|
HC SOM THALLIUM URINE
|
Facility
OP
|
$204.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$21.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.36
|
| Rate for Payer: BCBS Transplant Transplant |
$122.40
|
| Rate for Payer: Blue Shield of California Commercial |
$126.07
|
| Rate for Payer: Blue Shield of California EPN |
$99.14
|
| Rate for Payer: Caremore Medicare Advantage |
$21.96
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.96
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$153.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.01
|
| Rate for Payer: IEHP medi-cal |
$36.23
|
| Rate for Payer: IEHP Medicare Advantage |
$21.96
|
| Rate for Payer: Innovage PACE Commercial |
$32.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Prime Health Services Medicare |
$23.28
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: Riverside University Health MISP |
$24.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.78
|
| Rate for Payer: United Healthcare All Other HMO |
$17.78
|
| Rate for Payer: United Healthcare HMO Rider |
$17.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.16
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC SOM THALLIUM URINE
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
900911102
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
