|
HC SOM TISSUE CULTURE NEOPLASTIC
|
Facility
IP
|
$325.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910765
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Central Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.00
|
| Rate for Payer: Galaxy Health WC |
$276.25
|
| Rate for Payer: Global Benefits Group Commercial |
$195.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$216.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$243.75
|
| Rate for Payer: Networks By Design Commercial |
$211.25
|
| Rate for Payer: Prime Health Services Commercial |
$276.25
|
|
|
HC SOM TISSUE TRANSGLT AB IGA
|
Facility
IP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
|
|
HC SOM TISSUE TRANSGLT AB IGA
|
Facility
OP
|
$14.75
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$8.85
|
| Rate for Payer: Blue Shield of California Commercial |
$9.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.17
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Cash Price |
$6.64
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: Cigna of CA HMO |
$9.44
|
| Rate for Payer: Cigna of CA PPO |
$10.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| 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 |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: IEHP medi-cal |
$19.02
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Innovage PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| 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 |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.85
|
| Rate for Payer: Riverside University Health MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.85
|
| 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 TMP 80299
|
Facility
OP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| 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 |
$11.77
|
| Rate for Payer: Blue Shield of California Commercial |
$12.12
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Central Health Plan Commercial |
$15.69
|
| Rate for Payer: Cigna of CA HMO |
$12.55
|
| Rate for Payer: Cigna of CA PPO |
$14.51
|
| 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 |
$16.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.71
|
| 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 |
$13.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| 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 |
$14.71
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$16.67
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.77
|
| Rate for Payer: Riverside University Health MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.77
|
| 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 TMP 80299
|
Facility
IP
|
$19.61
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$17.65 |
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Central Health Plan Commercial |
$15.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: Galaxy Health WC |
$16.67
|
| Rate for Payer: Global Benefits Group Commercial |
$11.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$14.71
|
| Rate for Payer: Networks By Design Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Commercial |
$16.67
|
|
|
HC SOM TOPIRAMATE
|
Facility
OP
|
$17.50
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
900910764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$131.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.43
|
| Rate for Payer: BCBS Transplant Transplant |
$10.50
|
| Rate for Payer: Blue Shield of California Commercial |
$10.82
|
| Rate for Payer: Blue Shield of California EPN |
$8.50
|
| Rate for Payer: Caremore Medicare Advantage |
$11.92
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Central Health Plan Commercial |
$14.00
|
| Rate for Payer: Cigna of CA HMO |
$11.20
|
| Rate for Payer: Cigna of CA PPO |
$12.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.92
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.55
|
| Rate for Payer: IEHP medi-cal |
$19.67
|
| Rate for Payer: IEHP Medicare Advantage |
$11.92
|
| Rate for Payer: Innovage PACE Commercial |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.97
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
| Rate for Payer: Prime Health Services Medicare |
$12.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.50
|
| Rate for Payer: Riverside University Health MISP |
$13.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.66
|
| Rate for Payer: United Healthcare All Other HMO |
$9.66
|
| Rate for Payer: United Healthcare HMO Rider |
$9.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.11
|
| Rate for Payer: Vantage Medical Group Senior |
$11.92
|
|
|
HC SOM TOPIRAMATE
|
Facility
IP
|
$17.50
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
900910764
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Central Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.00
|
| Rate for Payer: Galaxy Health WC |
$14.88
|
| Rate for Payer: Global Benefits Group Commercial |
$10.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$13.12
|
| Rate for Payer: Networks By Design Commercial |
$11.38
|
| Rate for Payer: Prime Health Services Commercial |
$14.88
|
|
|
HC SOMTOX 20323 DRUG SCRN 11
|
Facility
IP
|
$155.03
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900914758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$139.53 |
| Rate for Payer: Cash Price |
$69.76
|
| Rate for Payer: Central Health Plan Commercial |
$124.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.01
|
| Rate for Payer: Galaxy Health WC |
$131.78
|
| Rate for Payer: Global Benefits Group Commercial |
$93.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.01
|
| Rate for Payer: Multiplan Commercial |
$116.27
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$131.78
|
|
|
HC SOMTOX 20323 DRUG SCRN 11
|
Facility
OP
|
$155.03
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900914758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.01 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.80
|
| Rate for Payer: BCBS Transplant Transplant |
$93.02
|
| Rate for Payer: Blue Shield of California Commercial |
$95.81
|
| Rate for Payer: Blue Shield of California EPN |
$75.34
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$69.76
|
| Rate for Payer: Cash Price |
$69.76
|
| Rate for Payer: Central Health Plan Commercial |
$124.02
|
| Rate for Payer: Cigna of CA HMO |
$99.22
|
| Rate for Payer: Cigna of CA PPO |
$114.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$131.78
|
| Rate for Payer: Global Benefits Group Commercial |
$93.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$139.53
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$116.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: IEHP medi-cal |
$102.53
|
| Rate for Payer: IEHP Medicare Advantage |
$62.14
|
| Rate for Payer: Innovage PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$103.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$116.27
|
| Rate for Payer: Networks By Design Commercial |
$100.77
|
| Rate for Payer: Prime Health Services Commercial |
$131.78
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$93.02
|
| Rate for Payer: Riverside University Health MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM TOXOCARA AB
|
Facility
IP
|
$40.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911594
|
|
Hospital Revenue Code
|
302
|
| 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 TOXOCARA AB
|
Facility
OP
|
$40.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911594
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| 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: 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 |
$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 |
$13.01
|
| 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 |
$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 |
$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: 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 |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| 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 |
$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 |
$13.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: Riverside University Health MISP |
$14.31
|
| 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 |
$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 TOXOPLASMA AB CSF IGG
|
Facility
IP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Central Health Plan Commercial |
$69.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.94
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
| Rate for Payer: Networks By Design Commercial |
$56.78
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
|
|
HC SOM TOXOPLASMA AB CSF IGG
|
Facility
OP
|
$87.36
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900911346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$127.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.31
|
| Rate for Payer: BCBS Transplant Transplant |
$52.42
|
| Rate for Payer: Blue Shield of California Commercial |
$53.99
|
| Rate for Payer: Blue Shield of California EPN |
$42.46
|
| Rate for Payer: Caremore Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Central Health Plan Commercial |
$69.89
|
| Rate for Payer: Cigna of CA HMO |
$55.91
|
| Rate for Payer: Cigna of CA PPO |
$64.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$74.26
|
| Rate for Payer: Global Benefits Group Commercial |
$52.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$65.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: IEHP medi-cal |
$23.74
|
| Rate for Payer: IEHP Medicare Advantage |
$14.39
|
| Rate for Payer: Innovage PACE Commercial |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$65.52
|
| Rate for Payer: Networks By Design Commercial |
$56.78
|
| Rate for Payer: Prime Health Services Commercial |
$74.26
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: Riverside University Health MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
IP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$78.74 |
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Central Health Plan Commercial |
$69.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.00
|
| Rate for Payer: Galaxy Health WC |
$74.37
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: Networks By Design Commercial |
$56.87
|
| Rate for Payer: Prime Health Services Commercial |
$74.37
|
|
|
HC SOM TOXOPLASMA AB CSF IGM
|
Facility
OP
|
$87.49
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900914413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$132.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.14
|
| Rate for Payer: BCBS Transplant Transplant |
$52.49
|
| Rate for Payer: Blue Shield of California Commercial |
$54.07
|
| Rate for Payer: Blue Shield of California EPN |
$42.52
|
| Rate for Payer: Caremore Medicare Advantage |
$14.41
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Central Health Plan Commercial |
$69.99
|
| Rate for Payer: Cigna of CA HMO |
$55.99
|
| Rate for Payer: Cigna of CA PPO |
$64.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$74.37
|
| Rate for Payer: Global Benefits Group Commercial |
$52.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$65.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.63
|
| Rate for Payer: IEHP medi-cal |
$23.78
|
| Rate for Payer: IEHP Medicare Advantage |
$14.41
|
| Rate for Payer: Innovage PACE Commercial |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$65.62
|
| Rate for Payer: Networks By Design Commercial |
$56.87
|
| Rate for Payer: Prime Health Services Commercial |
$74.37
|
| Rate for Payer: Prime Health Services Medicare |
$15.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$52.49
|
| Rate for Payer: Riverside University Health MISP |
$15.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC SOM TOXOPLASMA GONDII BY PCR
|
Facility
IP
|
$85.20
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$76.68 |
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Central Health Plan Commercial |
$68.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.08
|
| Rate for Payer: Galaxy Health WC |
$72.42
|
| Rate for Payer: Global Benefits Group Commercial |
$51.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$63.90
|
| Rate for Payer: Networks By Design Commercial |
$55.38
|
| Rate for Payer: Prime Health Services Commercial |
$72.42
|
|
|
HC SOM TOXOPLASMA GONDII BY PCR
|
Facility
OP
|
$85.20
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: BCBS Transplant Transplant |
$51.12
|
| Rate for Payer: Blue Shield of California Commercial |
$52.65
|
| Rate for Payer: Blue Shield of California EPN |
$41.41
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Cash Price |
$38.34
|
| Rate for Payer: Central Health Plan Commercial |
$68.16
|
| Rate for Payer: Cigna of CA HMO |
$54.53
|
| Rate for Payer: Cigna of CA PPO |
$63.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$72.42
|
| Rate for Payer: Global Benefits Group Commercial |
$51.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: IEHP medi-cal |
$57.90
|
| Rate for Payer: IEHP Medicare Advantage |
$35.09
|
| Rate for Payer: Innovage PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$63.90
|
| Rate for Payer: Networks By Design Commercial |
$55.38
|
| Rate for Payer: Prime Health Services Commercial |
$72.42
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.12
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM TPMT
|
Facility
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$15.52
|
| Rate for Payer: Blue Shield of California Commercial |
$15.98
|
| Rate for Payer: Blue Shield of California EPN |
$12.57
|
| Rate for Payer: Caremore Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA PPO |
$19.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: IEHP medi-cal |
$36.58
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Innovage PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.52
|
| Rate for Payer: Riverside University Health MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TPMT
|
Facility
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914732
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.34
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
|
|
HC SOM TPMT ACTIVITY PROFILE
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.20
|
| Rate for Payer: BCBS Transplant Transplant |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$83.43
|
| Rate for Payer: Blue Shield of California EPN |
$65.61
|
| Rate for Payer: Caremore Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$101.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: IEHP medi-cal |
$36.58
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Innovage PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: Riverside University Health MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM TPMT ACTIVITY PROFILE
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 84433
|
| Hospital Charge Code |
900915441
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC SOM TPPA 86780
|
Facility
IP
|
$37.51
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Central Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.00
|
| Rate for Payer: Galaxy Health WC |
$31.88
|
| Rate for Payer: Global Benefits Group Commercial |
$22.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$28.13
|
| Rate for Payer: Networks By Design Commercial |
$24.38
|
| Rate for Payer: Prime Health Services Commercial |
$31.88
|
|
|
HC SOM TPPA 86780
|
Facility
OP
|
$37.51
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914807
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$153.95 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.95
|
| Rate for Payer: BCBS Transplant Transplant |
$22.51
|
| Rate for Payer: Blue Shield of California Commercial |
$23.18
|
| Rate for Payer: Blue Shield of California EPN |
$18.23
|
| Rate for Payer: Caremore Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Central Health Plan Commercial |
$30.01
|
| Rate for Payer: Cigna of CA HMO |
$24.01
|
| Rate for Payer: Cigna of CA PPO |
$27.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$31.88
|
| Rate for Payer: Global Benefits Group Commercial |
$22.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: IEHP medi-cal |
$21.85
|
| Rate for Payer: IEHP Medicare Advantage |
$13.24
|
| Rate for Payer: Innovage PACE Commercial |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$28.13
|
| Rate for Payer: Networks By Design Commercial |
$24.38
|
| Rate for Payer: Prime Health Services Commercial |
$31.88
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.51
|
| Rate for Payer: Riverside University Health MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM TPPTL 82657
|
Facility
IP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.34
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
|
|
HC SOM TPPTL 82657
|
Facility
OP
|
$25.86
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914893
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$15.52
|
| Rate for Payer: Blue Shield of California Commercial |
$15.98
|
| Rate for Payer: Blue Shield of California EPN |
$12.57
|
| Rate for Payer: Caremore Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Cash Price |
$11.64
|
| Rate for Payer: Central Health Plan Commercial |
$20.69
|
| Rate for Payer: Cigna of CA HMO |
$16.55
|
| Rate for Payer: Cigna of CA PPO |
$19.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$21.98
|
| Rate for Payer: Global Benefits Group Commercial |
$15.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.27
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: IEHP medi-cal |
$36.58
|
| Rate for Payer: IEHP Medicare Advantage |
$22.17
|
| Rate for Payer: Innovage PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$19.40
|
| Rate for Payer: Networks By Design Commercial |
$16.81
|
| Rate for Payer: Prime Health Services Commercial |
$21.98
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.52
|
| Rate for Payer: Riverside University Health MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.96
|
| Rate for Payer: United Healthcare All Other HMO |
$17.96
|
| Rate for Payer: United Healthcare HMO Rider |
$17.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
