|
HC SOM CIF IMMUNOFLUOR ANTB 1ST STAIN
|
Facility
|
IP
|
$61.76
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900915525
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$55.58 |
| Rate for Payer: Adventist Health Commercial |
$12.35
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Central Health Plan Commercial |
$49.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.70
|
| Rate for Payer: EPIC Health Plan Senior |
$24.70
|
| Rate for Payer: Galaxy Health WC |
$52.50
|
| Rate for Payer: Global Benefits Group Commercial |
$37.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.35
|
| Rate for Payer: Multiplan Commercial |
$46.32
|
| Rate for Payer: Networks By Design Commercial |
$40.14
|
| Rate for Payer: Prime Health Services Commercial |
$52.50
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB 1ST STAIN
|
Facility
|
OP
|
$61.76
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
900915525
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$386.06 |
| Rate for Payer: Adventist Health Commercial |
$12.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$386.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.33
|
| Rate for Payer: Blue Shield of California Commercial |
$38.91
|
| Rate for Payer: Blue Shield of California EPN |
$24.52
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Cash Price |
$61.76
|
| Rate for Payer: Central Health Plan Commercial |
$49.41
|
| Rate for Payer: Cigna of CA HMO |
$39.53
|
| Rate for Payer: Cigna of CA PPO |
$45.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$52.50
|
| Rate for Payer: Global Benefits Group Commercial |
$37.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$46.32
|
| Rate for Payer: Networks By Design Commercial |
$40.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$52.50
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
900915526
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Adventist Health Commercial |
$9.45
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Central Health Plan Commercial |
$37.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.90
|
| Rate for Payer: EPIC Health Plan Senior |
$18.90
|
| Rate for Payer: Galaxy Health WC |
$40.15
|
| Rate for Payer: Global Benefits Group Commercial |
$28.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.45
|
| Rate for Payer: Multiplan Commercial |
$35.43
|
| Rate for Payer: Networks By Design Commercial |
$30.71
|
| Rate for Payer: Prime Health Services Commercial |
$40.15
|
|
|
HC SOM CIF IMMUNOFLUOR ANTB ADDL STAIN
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
900915526
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$561.27 |
| Rate for Payer: Adventist Health Commercial |
$9.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$403.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$561.27
|
| Rate for Payer: Blue Shield of California Commercial |
$29.76
|
| Rate for Payer: Blue Shield of California EPN |
$18.75
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Cash Price |
$47.24
|
| Rate for Payer: Central Health Plan Commercial |
$37.79
|
| Rate for Payer: Cigna of CA HMO |
$30.23
|
| Rate for Payer: Cigna of CA PPO |
$34.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.90
|
| Rate for Payer: EPIC Health Plan Senior |
$18.90
|
| Rate for Payer: Galaxy Health WC |
$40.15
|
| Rate for Payer: Global Benefits Group Commercial |
$28.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.07
|
| Rate for Payer: Multiplan Commercial |
$35.43
|
| Rate for Payer: Networks By Design Commercial |
$30.71
|
| Rate for Payer: Prime Health Services Commercial |
$40.15
|
| Rate for Payer: Riverside University Health System MISP |
$18.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.72
|
| Rate for Payer: United Healthcare All Other HMO |
$73.72
|
| Rate for Payer: United Healthcare HMO Rider |
$73.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.15
|
| Rate for Payer: Vantage Medical Group Senior |
$40.15
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$4,257.93 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$250.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,257.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$620.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$862.70
|
| Rate for Payer: Blue Shield of California Commercial |
$204.90
|
| Rate for Payer: Blue Shield of California EPN |
$129.12
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$376.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.79
|
| Rate for Payer: EPIC Health Plan Senior |
$275.86
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$411.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$351.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$336.05
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$250.78
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Prime Health Services Medicare |
$265.83
|
| Rate for Payer: Riverside University Health System MISP |
$275.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.13
|
| Rate for Payer: United Healthcare All Other HMO |
$203.13
|
| Rate for Payer: United Healthcare HMO Rider |
$203.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$250.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$376.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.86
|
| Rate for Payer: Vantage Medical Group Senior |
$250.78
|
|
|
HC SOM CIRC TUMOR PROS FLOW
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86152
|
| Hospital Charge Code |
900914391
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
IP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$292.72 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
|
|
HC SOM CIRC TUMOR PROS MARK
|
Facility
|
OP
|
$325.24
|
|
|
Service Code
|
CPT 86153
|
| Hospital Charge Code |
900914392
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$920.36 |
| Rate for Payer: Adventist Health Commercial |
$65.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$178.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$154.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.10
|
| Rate for Payer: Blue Shield of California Commercial |
$204.90
|
| Rate for Payer: Blue Shield of California EPN |
$129.12
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Central Health Plan Commercial |
$260.19
|
| Rate for Payer: Cigna of CA HMO |
$208.15
|
| Rate for Payer: Cigna of CA PPO |
$240.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$276.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$276.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$276.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$227.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.10
|
| Rate for Payer: EPIC Health Plan Senior |
$130.10
|
| Rate for Payer: Galaxy Health WC |
$276.45
|
| Rate for Payer: Global Benefits Group Commercial |
$195.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$292.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$206.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$227.67
|
| Rate for Payer: Multiplan Commercial |
$243.93
|
| Rate for Payer: Networks By Design Commercial |
$211.41
|
| Rate for Payer: Prime Health Services Commercial |
$276.45
|
| Rate for Payer: Riverside University Health System MISP |
$130.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$195.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$195.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.62
|
| Rate for Payer: United Healthcare All Other HMO |
$162.62
|
| Rate for Payer: United Healthcare HMO Rider |
$162.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$162.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$276.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Vantage Medical Group Senior |
$276.45
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$281.14 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$204.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$202.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.14
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.87
|
| Rate for Payer: EPIC Health Plan Senior |
$30.58
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.80
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$29.47
|
| Rate for Payer: Riverside University Health System MISP |
$30.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.52
|
| Rate for Payer: United Healthcare All Other HMO |
$22.52
|
| Rate for Payer: United Healthcare HMO Rider |
$22.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.52
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.58
|
| Rate for Payer: Vantage Medical Group Senior |
$27.80
|
|
|
HC SOM CITRIC ACID URINE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
900911053
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
IP
|
$29.78
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$26.80 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.91
|
| Rate for Payer: EPIC Health Plan Senior |
$11.91
|
| Rate for Payer: Galaxy Health WC |
$25.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Multiplan Commercial |
$22.34
|
| Rate for Payer: Networks By Design Commercial |
$19.36
|
| Rate for Payer: Prime Health Services Commercial |
$25.31
|
|
|
HC SOM CLONAZEPAM (CLONOPIN)
|
Facility
|
OP
|
$29.78
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$5.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care 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 |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$18.76
|
| Rate for Payer: Blue Shield of California EPN |
$11.82
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Central Health Plan Commercial |
$23.82
|
| Rate for Payer: Cigna of CA HMO |
$19.06
|
| Rate for Payer: Cigna of CA PPO |
$22.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$25.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$22.34
|
| Rate for Payer: Networks By Design Commercial |
$19.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$25.31
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.87
|
| 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: Upland Medical Group Pediatric |
$18.64
|
| 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 CLOZAPINE LEVEL
|
Facility
|
OP
|
$27.01
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$131.61 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.55
|
| Rate for Payer: Blue Shield of California Commercial |
$17.02
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Central Health Plan Commercial |
$21.61
|
| Rate for Payer: Cigna of CA HMO |
$17.29
|
| Rate for Payer: Cigna of CA PPO |
$19.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.25
|
| Rate for Payer: EPIC Health Plan Senior |
$22.16
|
| Rate for Payer: Galaxy Health WC |
$22.96
|
| Rate for Payer: Global Benefits Group Commercial |
$16.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$20.26
|
| Rate for Payer: Networks By Design Commercial |
$17.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$22.96
|
| Rate for Payer: Prime Health Services Medicare |
$21.36
|
| Rate for Payer: Riverside University Health System MISP |
$22.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.33
|
| Rate for Payer: United Healthcare All Other HMO |
$16.33
|
| Rate for Payer: United Healthcare HMO Rider |
$16.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.16
|
| Rate for Payer: Vantage Medical Group Senior |
$20.15
|
|
|
HC SOM CLOZAPINE LEVEL
|
Facility
|
IP
|
$27.01
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
900911438
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$24.31 |
| Rate for Payer: Adventist Health Commercial |
$5.40
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Central Health Plan Commercial |
$21.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Senior |
$10.80
|
| Rate for Payer: Galaxy Health WC |
$22.96
|
| Rate for Payer: Global Benefits Group Commercial |
$16.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$20.26
|
| Rate for Payer: Networks By Design Commercial |
$17.56
|
| Rate for Payer: Prime Health Services Commercial |
$22.96
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care 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 |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| 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: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| 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 |
$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: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM CMV PCR NON-BLOOD
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
900912519
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| 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 CMVQU 87497
|
Facility
|
IP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$300.51 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Central Health Plan Commercial |
$267.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.56
|
| Rate for Payer: EPIC Health Plan Senior |
$133.56
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.78
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Networks By Design Commercial |
$217.03
|
| Rate for Payer: Prime Health Services Commercial |
$283.81
|
|
|
HC SOM CMVQU 87497
|
Facility
|
OP
|
$333.90
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
900915269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$66.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$210.36
|
| Rate for Payer: Blue Shield of California EPN |
$132.56
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Cash Price |
$333.90
|
| Rate for Payer: Central Health Plan Commercial |
$267.12
|
| Rate for Payer: Cigna of CA HMO |
$213.70
|
| Rate for Payer: Cigna of CA PPO |
$247.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$283.81
|
| Rate for Payer: Global Benefits Group Commercial |
$200.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$300.51
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Networks By Design Commercial |
$217.03
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$283.81
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$200.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$200.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SOM CNS DEMYELINATING MOG FACS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$176.40
|
| Rate for Payer: Blue Shield of California EPN |
$111.16
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Senior |
$112.00
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
|
|
HC SOM CNS DEMYELINATING NMO/AQP4 FACS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915330
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Adventist Health Commercial |
$56.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.32
|
| Rate for Payer: Blue Shield of California Commercial |
$176.40
|
| Rate for Payer: Blue Shield of California EPN |
$111.16
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Central Health Plan Commercial |
$224.00
|
| Rate for Payer: Cigna of CA HMO |
$179.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$238.00
|
| Rate for Payer: Global Benefits Group Commercial |
$168.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$252.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$210.00
|
| Rate for Payer: Networks By Design Commercial |
$182.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$238.00
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
OP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$181.12 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.12
|
| Rate for Payer: Blue Shield of California Commercial |
$47.45
|
| Rate for Payer: Blue Shield of California EPN |
$29.90
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Central Health Plan Commercial |
$60.26
|
| Rate for Payer: Cigna of CA HMO |
$48.20
|
| Rate for Payer: Cigna of CA PPO |
$55.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.54
|
| Rate for Payer: EPIC Health Plan Senior |
$19.69
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.99
|
| Rate for Payer: Multiplan Commercial |
$56.49
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.90
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
| Rate for Payer: Prime Health Services Medicare |
$18.97
|
| Rate for Payer: Riverside University Health System MISP |
$19.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.50
|
| Rate for Payer: United Healthcare All Other HMO |
$14.50
|
| Rate for Payer: United Healthcare HMO Rider |
$14.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.69
|
| Rate for Payer: Vantage Medical Group Senior |
$17.90
|
|
|
HC SOM COAG FACTOR VIII ASSAY
|
Facility
|
IP
|
$75.32
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
900913969
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$67.79 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$75.32
|
| Rate for Payer: Central Health Plan Commercial |
$60.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.13
|
| Rate for Payer: EPIC Health Plan Senior |
$30.13
|
| Rate for Payer: Galaxy Health WC |
$64.02
|
| Rate for Payer: Global Benefits Group Commercial |
$45.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$56.49
|
| Rate for Payer: Networks By Design Commercial |
$48.96
|
| Rate for Payer: Prime Health Services Commercial |
$64.02
|
|
|
HC SOM COAG FVIII INHIB SCREEN
|
Facility
|
OP
|
$222.45
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900913971
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$200.21 |
| Rate for Payer: Adventist Health Commercial |
$44.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.19
|
| Rate for Payer: Blue Shield of California Commercial |
$140.14
|
| Rate for Payer: Blue Shield of California EPN |
$88.31
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Cash Price |
$222.45
|
| Rate for Payer: Central Health Plan Commercial |
$177.96
|
| Rate for Payer: Cigna of CA HMO |
$142.37
|
| Rate for Payer: Cigna of CA PPO |
$164.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$155.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$189.08
|
| Rate for Payer: Global Benefits Group Commercial |
$133.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$141.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$166.84
|
| Rate for Payer: Networks By Design Commercial |
$144.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$189.08
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
