|
HC SOM UREAPLASMA PCR
|
Facility
OP
|
$37.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900912878
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.50 |
| 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 |
$22.50
|
| Rate for Payer: Blue Shield of California Commercial |
$23.18
|
| Rate for Payer: Blue Shield of California EPN |
$18.22
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Cash Price |
$16.88
|
| Rate for Payer: Central Health Plan Commercial |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$24.00
|
| Rate for Payer: Cigna of CA PPO |
$27.75
|
| 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 |
$31.88
|
| Rate for Payer: Global Benefits Group Commercial |
$22.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.12
|
| 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 |
$25.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.50
|
| 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 |
$28.12
|
| 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 |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.50
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.50
|
| 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 VARICELLA ZOSTER ANTIBODY
|
Facility
OP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$8.50
|
| Rate for Payer: Blue Shield of California Commercial |
$8.76
|
| Rate for Payer: Blue Shield of California EPN |
$6.89
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: Cigna of CA HMO |
$9.07
|
| Rate for Payer: Cigna of CA PPO |
$10.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM VARICELLA ZOSTER ANTIBODY
|
Facility
IP
|
$14.17
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900912868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Central Health Plan Commercial |
$11.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.67
|
| Rate for Payer: Galaxy Health WC |
$12.04
|
| Rate for Payer: Global Benefits Group Commercial |
$8.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$10.63
|
| Rate for Payer: Networks By Design Commercial |
$9.21
|
| Rate for Payer: Prime Health Services Commercial |
$12.04
|
|
|
HC SOM VASCULITIS PANEL P3 AB
|
Facility
IP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
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 SOM VASCULITIS PANEL P3 AB
|
Facility
OP
|
$17.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900912702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.50 |
| 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 |
$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 |
$11.53
|
| 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 |
$17.30
|
| 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 |
$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 |
$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 |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.50
|
| 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 |
$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 |
$12.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.50
|
| Rate for Payer: Riverside University Health MISP |
$12.68
|
| 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 |
$9.34
|
| 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 VASOACTIVE INTESTINAL PEPTIDE
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM VASOACTIVE INTESTINAL PEPTIDE
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
900911186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.89
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.33
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.94
|
| Rate for Payer: IEHP medi-cal |
$58.29
|
| Rate for Payer: IEHP Medicare Advantage |
$35.33
|
| Rate for Payer: Innovage PACE Commercial |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.34
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$37.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Riverside University Health MISP |
$38.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.62
|
| Rate for Payer: United Healthcare All Other HMO |
$28.62
|
| Rate for Payer: United Healthcare HMO Rider |
$28.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.86
|
| Rate for Payer: Vantage Medical Group Senior |
$35.33
|
|
|
HC SOM VDER 87529
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| 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 |
$30.16
|
| Rate for Payer: Blue Shield of California Commercial |
$31.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.43
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| 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 |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.70
|
| 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 |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| 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 |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| 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 VDER 87529
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
900913965
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM VDER 87798
|
Facility
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC SOM VDER 87798
|
Facility
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913966
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| 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 |
$30.16
|
| Rate for Payer: Blue Shield of California Commercial |
$31.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.43
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| 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 |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.70
|
| 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 |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| 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 |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: Riverside University Health MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| 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 VEDOLIZUMAB AB
|
Facility
OP
|
$62.98
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.39
|
| Rate for Payer: BCBS Transplant Transplant |
$37.79
|
| Rate for Payer: Blue Shield of California Commercial |
$38.92
|
| Rate for Payer: Blue Shield of California EPN |
$30.61
|
| Rate for Payer: Caremore Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Central Health Plan Commercial |
$50.38
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$47.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: IEHP medi-cal |
$23.30
|
| Rate for Payer: IEHP Medicare Advantage |
$14.12
|
| Rate for Payer: Innovage PACE Commercial |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: Riverside University Health MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM VEDOLIZUMAB AB
|
Facility
IP
|
$62.98
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$56.68 |
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Central Health Plan Commercial |
$50.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
|
|
HC SOM VEDOLIZUMAB QN
|
Facility
IP
|
$172.02
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
900915324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.82 |
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Central Health Plan Commercial |
$137.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.81
|
| Rate for Payer: Galaxy Health WC |
$146.22
|
| Rate for Payer: Global Benefits Group Commercial |
$103.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.02
|
| Rate for Payer: Networks By Design Commercial |
$111.81
|
| Rate for Payer: Prime Health Services Commercial |
$146.22
|
|
|
HC SOM VEDOLIZUMAB QN
|
Facility
OP
|
$172.02
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
900915324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.27
|
| Rate for Payer: BCBS Transplant Transplant |
$103.21
|
| Rate for Payer: Blue Shield of California Commercial |
$106.31
|
| Rate for Payer: Blue Shield of California EPN |
$83.60
|
| Rate for Payer: Caremore Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Cash Price |
$77.41
|
| Rate for Payer: Central Health Plan Commercial |
$137.62
|
| Rate for Payer: Cigna of CA HMO |
$110.09
|
| Rate for Payer: Cigna of CA PPO |
$127.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$146.22
|
| Rate for Payer: Global Benefits Group Commercial |
$103.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$129.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: IEHP medi-cal |
$63.64
|
| Rate for Payer: IEHP Medicare Advantage |
$38.57
|
| Rate for Payer: Innovage PACE Commercial |
$57.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$129.02
|
| Rate for Payer: Networks By Design Commercial |
$111.81
|
| Rate for Payer: Prime Health Services Commercial |
$146.22
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$103.21
|
| Rate for Payer: Riverside University Health MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM VITAMIN A
|
Facility
OP
|
$17.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$102.87 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.87
|
| Rate for Payer: BCBS Transplant Transplant |
$10.74
|
| Rate for Payer: Blue Shield of California Commercial |
$11.06
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Caremore Medicare Advantage |
$11.61
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.67
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.61
|
| Rate for Payer: Galaxy Health WC |
$15.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.04
|
| Rate for Payer: IEHP medi-cal |
$19.16
|
| Rate for Payer: IEHP Medicare Advantage |
$11.61
|
| Rate for Payer: Innovage PACE Commercial |
$17.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.56
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$11.64
|
| Rate for Payer: Prime Health Services Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Medicare |
$12.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: Riverside University Health MISP |
$12.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.40
|
| Rate for Payer: United Healthcare All Other HMO |
$9.40
|
| Rate for Payer: United Healthcare HMO Rider |
$9.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Vantage Medical Group Senior |
$11.61
|
|
|
HC SOM VITAMIN A
|
Facility
IP
|
$17.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.22
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$13.42
|
| Rate for Payer: Networks By Design Commercial |
$11.64
|
| Rate for Payer: Prime Health Services Commercial |
$15.22
|
|
|
HC SOM VITAMIN B1 (THIAMINE)
|
Facility
IP
|
$22.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM VITAMIN B1 (THIAMINE)
|
Facility
OP
|
$22.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$160.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$21.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$21.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.04
|
| Rate for Payer: BCBS Transplant Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.23
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.82
|
| Rate for Payer: IEHP medi-cal |
$35.03
|
| Rate for Payer: IEHP Medicare Advantage |
$21.23
|
| Rate for Payer: Innovage PACE Commercial |
$31.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.45
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$22.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: Riverside University Health MISP |
$23.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.20
|
| Rate for Payer: United Healthcare All Other HMO |
$17.20
|
| Rate for Payer: United Healthcare HMO Rider |
$17.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: Vantage Medical Group Senior |
$21.23
|
|
|
HC SOM VITAMIN B6
|
Facility
IP
|
$28.25
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$25.42 |
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Central Health Plan Commercial |
$22.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.30
|
| Rate for Payer: Galaxy Health WC |
$24.01
|
| Rate for Payer: Global Benefits Group Commercial |
$16.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.65
|
| Rate for Payer: Multiplan Commercial |
$21.19
|
| Rate for Payer: Networks By Design Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$24.01
|
|
|
HC SOM VITAMIN B6
|
Facility
OP
|
$28.25
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$211.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$28.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$206.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$173.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.60
|
| Rate for Payer: BCBS Transplant Transplant |
$16.95
|
| Rate for Payer: Blue Shield of California Commercial |
$17.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.73
|
| Rate for Payer: Caremore Medicare Advantage |
$28.10
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Central Health Plan Commercial |
$22.60
|
| Rate for Payer: Cigna of CA HMO |
$18.08
|
| Rate for Payer: Cigna of CA PPO |
$20.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$28.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$24.01
|
| Rate for Payer: Global Benefits Group Commercial |
$16.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.42
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$46.08
|
| Rate for Payer: IEHP medi-cal |
$46.36
|
| Rate for Payer: IEHP Medicare Advantage |
$28.10
|
| Rate for Payer: Innovage PACE Commercial |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.65
|
| Rate for Payer: Multiplan Commercial |
$21.19
|
| Rate for Payer: Networks By Design Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$24.01
|
| Rate for Payer: Prime Health Services Medicare |
$29.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.95
|
| Rate for Payer: Riverside University Health MISP |
$30.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.76
|
| Rate for Payer: United Healthcare All Other HMO |
$22.76
|
| Rate for Payer: United Healthcare HMO Rider |
$22.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: Vantage Medical Group Senior |
$28.10
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$262.68 |
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$217.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.68
|
| Rate for Payer: BCBS Transplant Transplant |
$4.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4.94
|
| Rate for Payer: Blue Shield of California EPN |
$3.89
|
| Rate for Payer: Caremore Medicare Advantage |
$29.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: Cigna of CA HMO |
$5.12
|
| Rate for Payer: Cigna of CA PPO |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: IEHP medi-cal |
$48.84
|
| Rate for Payer: IEHP Medicare Advantage |
$29.60
|
| Rate for Payer: Innovage PACE Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Medicare |
$31.38
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: Riverside University Health MISP |
$32.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.00
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: IEHP medi-cal |
$15.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health MISP |
$18.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
