|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
OP
|
$26.28
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$154.02 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.02
|
| Rate for Payer: Blue Shield of California Commercial |
$16.56
|
| Rate for Payer: Blue Shield of California EPN |
$10.43
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Central Health Plan Commercial |
$21.02
|
| Rate for Payer: Cigna of CA HMO |
$16.82
|
| Rate for Payer: Cigna of CA PPO |
$19.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$22.34
|
| Rate for Payer: Global Benefits Group Commercial |
$15.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$19.71
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$22.34
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SOM MYOMARKER3 NUCLEAR AG AB
|
Facility
|
IP
|
$26.28
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900915485
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$23.65 |
| Rate for Payer: Adventist Health Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Central Health Plan Commercial |
$21.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.51
|
| Rate for Payer: EPIC Health Plan Senior |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$22.34
|
| Rate for Payer: Global Benefits Group Commercial |
$15.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$19.71
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: Prime Health Services Commercial |
$22.34
|
|
|
HC SOM NEOPTERIN
|
Facility
|
IP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.85 |
| Max. Negotiated Rate |
$161.32 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Central Health Plan Commercial |
$143.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.70
|
| Rate for Payer: EPIC Health Plan Senior |
$71.70
|
| Rate for Payer: Galaxy Health WC |
$152.36
|
| Rate for Payer: Global Benefits Group Commercial |
$107.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.85
|
| Rate for Payer: Multiplan Commercial |
$134.44
|
| Rate for Payer: Networks By Design Commercial |
$116.51
|
| Rate for Payer: Prime Health Services Commercial |
$152.36
|
|
|
HC SOM NEOPTERIN
|
Facility
|
OP
|
$179.25
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900913946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$161.32 |
| Rate for Payer: Adventist Health Commercial |
$35.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$112.93
|
| Rate for Payer: Blue Shield of California EPN |
$71.16
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Cash Price |
$179.25
|
| Rate for Payer: Central Health Plan Commercial |
$143.40
|
| Rate for Payer: Cigna of CA HMO |
$114.72
|
| Rate for Payer: Cigna of CA PPO |
$132.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$152.36
|
| Rate for Payer: Global Benefits Group Commercial |
$107.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$134.44
|
| Rate for Payer: Networks By Design Commercial |
$116.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$152.36
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEUROCONDRIN IFA
|
Facility
|
IP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$40.56 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.03
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
|
|
HC SOM NEUROCONDRIN IFA
|
Facility
|
OP
|
$45.07
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$9.01
|
| 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 |
$28.39
|
| Rate for Payer: Blue Shield of California EPN |
$17.89
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Cash Price |
$45.07
|
| Rate for Payer: Central Health Plan Commercial |
$36.06
|
| Rate for Payer: Cigna of CA HMO |
$28.84
|
| Rate for Payer: Cigna of CA PPO |
$33.35
|
| 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 |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$38.31
|
| Rate for Payer: Global Benefits Group Commercial |
$27.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.56
|
| 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 |
$28.62
|
| 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 |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$29.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$38.31
|
| 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 |
$27.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.04
|
| 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 NEURON SPECIFIC ENOLASE CSF
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
|
|
HC SOM NEURON SPECIFIC ENOLASE CSF
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910766
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$14.69
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM NEURON SPECIFIC ENOLASE SERUM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900910767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM NEUROTENSIN
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC SOM NEUROTENSIN
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900910768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.66
|
| Rate for Payer: Blue Shield of California Commercial |
$170.10
|
| Rate for Payer: Blue Shield of California EPN |
$107.19
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.36
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.00
|
| Rate for Payer: EPIC Health Plan Senior |
$78.00
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
|
|
HC SOM NEUROTRANSMITTER METAB
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914688
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$39.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$122.85
|
| Rate for Payer: Blue Shield of California EPN |
$77.42
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Central Health Plan Commercial |
$156.00
|
| Rate for Payer: Cigna of CA HMO |
$124.80
|
| Rate for Payer: Cigna of CA PPO |
$144.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$165.75
|
| Rate for Payer: Global Benefits Group Commercial |
$117.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$146.25
|
| Rate for Payer: Networks By Design Commercial |
$126.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$165.75
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
IP
|
$26.27
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$23.64 |
| Rate for Payer: Adventist Health Commercial |
$5.25
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Central Health Plan Commercial |
$21.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.51
|
| Rate for Payer: EPIC Health Plan Senior |
$10.51
|
| Rate for Payer: Galaxy Health WC |
$22.33
|
| Rate for Payer: Global Benefits Group Commercial |
$15.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$19.70
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: Prime Health Services Commercial |
$22.33
|
|
|
HC SOM N.GONORRHOEAE AMP DNA FEMALE U
|
Facility
|
OP
|
$26.27
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912876
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$5.25
|
| 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 |
$16.55
|
| Rate for Payer: Blue Shield of California EPN |
$10.43
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Cash Price |
$26.27
|
| Rate for Payer: Central Health Plan Commercial |
$21.02
|
| Rate for Payer: Cigna of CA HMO |
$16.81
|
| Rate for Payer: Cigna of CA PPO |
$19.44
|
| 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 |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$22.33
|
| Rate for Payer: Global Benefits Group Commercial |
$15.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$19.70
|
| Rate for Payer: Networks By Design Commercial |
$17.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$22.33
|
| 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 |
$15.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.76
|
| 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 NICOTINE
|
Facility
|
OP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$291.22 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.22
|
| Rate for Payer: Blue Shield of California Commercial |
$12.82
|
| Rate for Payer: Blue Shield of California EPN |
$8.08
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$16.28
|
| Rate for Payer: Cigna of CA HMO |
$13.02
|
| Rate for Payer: Cigna of CA PPO |
$15.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$8.14
|
| Rate for Payer: Galaxy Health WC |
$17.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.24
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.30
|
| Rate for Payer: Riverside University Health System MISP |
$8.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.18
|
| Rate for Payer: United Healthcare All Other HMO |
$10.18
|
| Rate for Payer: United Healthcare HMO Rider |
$10.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.30
|
| Rate for Payer: Vantage Medical Group Senior |
$17.30
|
|
|
HC SOM NICOTINE
|
Facility
|
IP
|
$20.35
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
900910769
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: Adventist Health Commercial |
$4.07
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$16.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.14
|
| Rate for Payer: EPIC Health Plan Senior |
$8.14
|
| Rate for Payer: Galaxy Health WC |
$17.30
|
| Rate for Payer: Global Benefits Group Commercial |
$12.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$15.26
|
| Rate for Payer: Networks By Design Commercial |
$13.23
|
| Rate for Payer: Prime Health Services Commercial |
$17.30
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
OP
|
$67.27
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Adventist Health Commercial |
$13.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.13
|
| Rate for Payer: Blue Shield of California Commercial |
$42.38
|
| Rate for Payer: Blue Shield of California EPN |
$26.71
|
| Rate for Payer: Cash Price |
$67.27
|
| Rate for Payer: Central Health Plan Commercial |
$53.82
|
| Rate for Payer: Cigna of CA HMO |
$43.05
|
| Rate for Payer: Cigna of CA PPO |
$49.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.91
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$57.18
|
| Rate for Payer: Global Benefits Group Commercial |
$40.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.09
|
| Rate for Payer: Multiplan Commercial |
$50.45
|
| Rate for Payer: Networks By Design Commercial |
$43.73
|
| Rate for Payer: Prime Health Services Commercial |
$57.18
|
| Rate for Payer: Riverside University Health System MISP |
$26.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.63
|
| Rate for Payer: United Healthcare All Other HMO |
$33.63
|
| Rate for Payer: United Healthcare HMO Rider |
$33.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.18
|
| Rate for Payer: Vantage Medical Group Senior |
$57.18
|
|
|
HC SOM NITROGEN STOOL
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900911229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Adventist Health Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$67.27
|
| Rate for Payer: Central Health Plan Commercial |
$53.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.91
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$57.18
|
| Rate for Payer: Global Benefits Group Commercial |
$40.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.45
|
| Rate for Payer: Multiplan Commercial |
$50.45
|
| Rate for Payer: Networks By Design Commercial |
$43.73
|
| Rate for Payer: Prime Health Services Commercial |
$57.18
|
|
|
HC SOM NMDCS 86255
|
Facility
|
IP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.87 |
| Max. Negotiated Rate |
$309.90 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Central Health Plan Commercial |
$275.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$241.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$137.73
|
| Rate for Payer: EPIC Health Plan Senior |
$137.73
|
| Rate for Payer: Galaxy Health WC |
$292.68
|
| Rate for Payer: Global Benefits Group Commercial |
$206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$218.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$203.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.87
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
| Rate for Payer: Networks By Design Commercial |
$223.81
|
| Rate for Payer: Prime Health Services Commercial |
$292.68
|
|
|
HC SOM NMDCS 86255
|
Facility
|
OP
|
$344.33
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900914769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$309.90 |
| Rate for Payer: Adventist Health Commercial |
$68.87
|
| 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 |
$216.93
|
| Rate for Payer: Blue Shield of California EPN |
$136.70
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Cash Price |
$344.33
|
| Rate for Payer: Central Health Plan Commercial |
$275.46
|
| Rate for Payer: Cigna of CA HMO |
$220.37
|
| Rate for Payer: Cigna of CA PPO |
$254.80
|
| 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 |
$241.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$292.68
|
| Rate for Payer: Global Benefits Group Commercial |
$206.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$309.90
|
| 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 |
$218.65
|
| 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 |
$68.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$258.25
|
| Rate for Payer: Networks By Design Commercial |
$223.81
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$292.68
|
| 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 |
$206.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$206.60
|
| 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 NMHIN 83789
|
Facility
|
IP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$146.21 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Central Health Plan Commercial |
$129.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.98
|
| Rate for Payer: EPIC Health Plan Senior |
$64.98
|
| Rate for Payer: Galaxy Health WC |
$138.08
|
| Rate for Payer: Global Benefits Group Commercial |
$97.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
| Rate for Payer: Networks By Design Commercial |
$105.59
|
| Rate for Payer: Prime Health Services Commercial |
$138.08
|
|
|
HC SOM NMHIN 83789
|
Facility
|
OP
|
$162.45
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914806
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$102.34
|
| Rate for Payer: Blue Shield of California EPN |
$64.49
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Central Health Plan Commercial |
$129.96
|
| Rate for Payer: Cigna of CA HMO |
$103.97
|
| Rate for Payer: Cigna of CA PPO |
$120.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$138.08
|
| Rate for Payer: Global Benefits Group Commercial |
$97.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$121.84
|
| Rate for Payer: Networks By Design Commercial |
$105.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.11
|
| Rate for Payer: Prime Health Services Commercial |
$138.08
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Riverside University Health System MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM NMO/AQP4 FACS
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 86053
|
| Hospital Charge Code |
900915463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Adventist Health Commercial |
$68.00
|
| 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 |
$214.20
|
| Rate for Payer: Blue Shield of California EPN |
$134.98
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Central Health Plan Commercial |
$272.00
|
| Rate for Payer: Cigna of CA HMO |
$217.60
|
| Rate for Payer: Cigna of CA PPO |
$251.60
|
| 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 |
$238.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$289.00
|
| Rate for Payer: Global Benefits Group Commercial |
$204.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$306.00
|
| 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 |
$215.90
|
| 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 |
$68.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$255.00
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$289.00
|
| 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 |
$204.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$204.00
|
| 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
|
|
