|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$203.32 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.32
|
| Rate for Payer: Blue Shield of California Commercial |
$15.73
|
| Rate for Payer: Blue Shield of California EPN |
$9.91
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Central Health Plan Commercial |
$19.98
|
| Rate for Payer: Cigna of CA HMO |
$15.98
|
| Rate for Payer: Cigna of CA PPO |
$18.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.19
|
| Rate for Payer: EPIC Health Plan Senior |
$30.13
|
| Rate for Payer: Galaxy Health WC |
$21.22
|
| Rate for Payer: Global Benefits Group Commercial |
$14.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.47
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.70
|
| Rate for Payer: Multiplan Commercial |
$18.73
|
| Rate for Payer: Networks By Design Commercial |
$16.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.39
|
| Rate for Payer: Prime Health Services Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Medicare |
$29.03
|
| Rate for Payer: Riverside University Health System MISP |
$30.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OLIGOCLONAL BANDS CSF
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900911235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Adventist Health Commercial |
$4.99
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Central Health Plan Commercial |
$19.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.99
|
| Rate for Payer: EPIC Health Plan Senior |
$9.99
|
| Rate for Payer: Galaxy Health WC |
$21.22
|
| Rate for Payer: Global Benefits Group Commercial |
$14.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$18.73
|
| Rate for Payer: Networks By Design Commercial |
$16.23
|
| Rate for Payer: Prime Health Services Commercial |
$21.22
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
OP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$203.32 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$146.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.32
|
| Rate for Payer: Blue Shield of California Commercial |
$14.40
|
| Rate for Payer: Blue Shield of California EPN |
$9.08
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: Cigna of CA HMO |
$14.63
|
| Rate for Payer: Cigna of CA PPO |
$16.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.19
|
| Rate for Payer: EPIC Health Plan Senior |
$30.13
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.70
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.39
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
| Rate for Payer: Prime Health Services Medicare |
$29.03
|
| Rate for Payer: Riverside University Health System MISP |
$30.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.13
|
| Rate for Payer: Vantage Medical Group Senior |
$27.39
|
|
|
HC SOM OLIGOCLONAL BANDS SERUM
|
Facility
|
IP
|
$22.86
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
900912657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$20.57 |
| Rate for Payer: Adventist Health Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Central Health Plan Commercial |
$18.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.14
|
| Rate for Payer: EPIC Health Plan Senior |
$9.14
|
| Rate for Payer: Galaxy Health WC |
$19.43
|
| Rate for Payer: Global Benefits Group Commercial |
$13.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.57
|
| Rate for Payer: Multiplan Commercial |
$17.14
|
| Rate for Payer: Networks By Design Commercial |
$14.86
|
| Rate for Payer: Prime Health Services Commercial |
$19.43
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$188.75 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.78
|
| Rate for Payer: Blue Shield of California EPN |
$5.53
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Cigna of CA HMO |
$8.92
|
| Rate for Payer: Cigna of CA PPO |
$10.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.75
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
| Rate for Payer: Riverside University Health System MISP |
$5.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6.96
|
| Rate for Payer: United Healthcare HMO Rider |
$6.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
| Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
|
HC SOM OPATU DRUG SCRN OXYCDN
|
Facility
|
IP
|
$13.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915279
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.54 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$13.93
|
| Rate for Payer: Central Health Plan Commercial |
$11.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$11.84
|
| Rate for Payer: Global Benefits Group Commercial |
$8.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.45
|
| Rate for Payer: Networks By Design Commercial |
$9.05
|
| Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$165.73 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.73
|
| Rate for Payer: Blue Shield of California Commercial |
$34.10
|
| Rate for Payer: Blue Shield of California EPN |
$21.49
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Cigna of CA HMO |
$34.64
|
| Rate for Payer: Cigna of CA PPO |
$40.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.14
|
| Rate for Payer: EPIC Health Plan Senior |
$18.09
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.04
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.45
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
| Rate for Payer: Prime Health Services Medicare |
$17.44
|
| Rate for Payer: Riverside University Health System MISP |
$18.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.33
|
| Rate for Payer: United Healthcare All Other HMO |
$13.33
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.09
|
| Rate for Payer: Vantage Medical Group Senior |
$16.45
|
|
|
HC SOM ORGANIC ACID SCREEN
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 83919
|
| Hospital Charge Code |
900911179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Adventist Health Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Central Health Plan Commercial |
$43.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.65
|
| Rate for Payer: EPIC Health Plan Senior |
$21.65
|
| Rate for Payer: Galaxy Health WC |
$46.00
|
| Rate for Payer: Global Benefits Group Commercial |
$32.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Multiplan Commercial |
$40.59
|
| Rate for Payer: Networks By Design Commercial |
$35.18
|
| Rate for Payer: Prime Health Services Commercial |
$46.00
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| 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: 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 |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| 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 |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| 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 |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, AEROBIC
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912887
|
|
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 ORG REFER FOR ID, ANAEROB
|
Facility
|
OP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.96
|
| Rate for Payer: Blue Shield of California EPN |
$9.42
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Central Health Plan Commercial |
$18.99
|
| Rate for Payer: Cigna of CA HMO |
$15.19
|
| Rate for Payer: Cigna of CA PPO |
$17.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$20.18
|
| Rate for Payer: Global Benefits Group Commercial |
$14.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
| Rate for Payer: Networks By Design Commercial |
$15.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$20.18
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM ORG REFER FOR ID, ANAEROB
|
Facility
|
IP
|
$23.74
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
900912889
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$21.37 |
| Rate for Payer: Adventist Health Commercial |
$4.75
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Central Health Plan Commercial |
$18.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.50
|
| Rate for Payer: EPIC Health Plan Senior |
$9.50
|
| Rate for Payer: Galaxy Health WC |
$20.18
|
| Rate for Payer: Global Benefits Group Commercial |
$14.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$17.80
|
| Rate for Payer: Networks By Design Commercial |
$15.43
|
| Rate for Payer: Prime Health Services Commercial |
$20.18
|
|
|
HC SOM OROT 83921
|
Facility
|
OP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$166.41 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.41
|
| Rate for Payer: Blue Shield of California Commercial |
$14.86
|
| Rate for Payer: Blue Shield of California EPN |
$9.36
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Central Health Plan Commercial |
$18.86
|
| Rate for Payer: Cigna of CA HMO |
$15.09
|
| Rate for Payer: Cigna of CA PPO |
$17.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23.33
|
| Rate for Payer: Galaxy Health WC |
$20.04
|
| Rate for Payer: Global Benefits Group Commercial |
$14.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$17.68
|
| Rate for Payer: Networks By Design Commercial |
$15.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.21
|
| Rate for Payer: Prime Health Services Commercial |
$20.04
|
| Rate for Payer: Prime Health Services Medicare |
$22.48
|
| Rate for Payer: Riverside University Health System MISP |
$23.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM OROT 83921
|
Facility
|
IP
|
$23.58
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900914729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$21.22 |
| Rate for Payer: Adventist Health Commercial |
$4.72
|
| Rate for Payer: Cash Price |
$23.58
|
| Rate for Payer: Central Health Plan Commercial |
$18.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.43
|
| Rate for Payer: EPIC Health Plan Senior |
$9.43
|
| Rate for Payer: Galaxy Health WC |
$20.04
|
| Rate for Payer: Global Benefits Group Commercial |
$14.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$17.68
|
| Rate for Payer: Networks By Design Commercial |
$15.33
|
| Rate for Payer: Prime Health Services Commercial |
$20.04
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$314.82 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.79
|
| Rate for Payer: Blue Shield of California Commercial |
$48.51
|
| Rate for Payer: Blue Shield of California EPN |
$30.57
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.45
|
| Rate for Payer: United Healthcare All Other HMO |
$41.45
|
| Rate for Payer: United Healthcare HMO Rider |
$41.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SOM ORTHOPOXVIRUS DNA - LABCORP
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
900915424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
OP
|
$60.06
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$208.98 |
| Rate for Payer: Adventist Health Commercial |
$12.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.41
|
| Rate for Payer: Blue Shield of California Commercial |
$37.84
|
| Rate for Payer: Blue Shield of California EPN |
$23.84
|
| Rate for Payer: Cash Price |
$60.06
|
| Rate for Payer: Cash Price |
$60.06
|
| Rate for Payer: Central Health Plan Commercial |
$48.05
|
| Rate for Payer: Cigna of CA HMO |
$38.44
|
| Rate for Payer: Cigna of CA PPO |
$44.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.25
|
| Rate for Payer: EPIC Health Plan Senior |
$32.84
|
| Rate for Payer: Galaxy Health WC |
$51.05
|
| Rate for Payer: Global Benefits Group Commercial |
$36.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$45.05
|
| Rate for Payer: Networks By Design Commercial |
$39.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$51.05
|
| Rate for Payer: Prime Health Services Medicare |
$31.64
|
| Rate for Payer: Riverside University Health System MISP |
$32.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.18
|
| Rate for Payer: United Healthcare All Other HMO |
$24.18
|
| Rate for Payer: United Healthcare HMO Rider |
$24.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.84
|
| Rate for Payer: Vantage Medical Group Senior |
$29.85
|
|
|
HC SOM OSTEOCALCIN
|
Facility
|
IP
|
$60.06
|
|
|
Service Code
|
CPT 83937
|
| Hospital Charge Code |
900911399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Adventist Health Commercial |
$12.01
|
| Rate for Payer: Cash Price |
$60.06
|
| Rate for Payer: Central Health Plan Commercial |
$48.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.02
|
| Rate for Payer: EPIC Health Plan Senior |
$24.02
|
| Rate for Payer: Galaxy Health WC |
$51.05
|
| Rate for Payer: Global Benefits Group Commercial |
$36.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$45.05
|
| Rate for Payer: Networks By Design Commercial |
$39.04
|
| Rate for Payer: Prime Health Services Commercial |
$51.05
|
|
|
HC SOM OXALATE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Adventist Health Commercial |
$4.33
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Central Health Plan Commercial |
$17.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.66
|
| Rate for Payer: EPIC Health Plan Senior |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$18.39
|
| Rate for Payer: Global Benefits Group Commercial |
$12.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: Prime Health Services Commercial |
$18.39
|
|
|
HC SOM OXALATE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900911124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Adventist Health Commercial |
$4.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| 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 |
$13.63
|
| Rate for Payer: Blue Shield of California EPN |
$8.59
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Central Health Plan Commercial |
$17.31
|
| Rate for Payer: Cigna of CA HMO |
$13.85
|
| Rate for Payer: Cigna of CA PPO |
$16.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.84
|
| Rate for Payer: EPIC Health Plan Senior |
$15.89
|
| Rate for Payer: Galaxy Health WC |
$18.39
|
| Rate for Payer: Global Benefits Group Commercial |
$12.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$16.23
|
| Rate for Payer: Networks By Design Commercial |
$14.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$18.39
|
| Rate for Payer: Prime Health Services Medicare |
$15.32
|
| Rate for Payer: Riverside University Health System MISP |
$15.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXALATE PLASMA
|
Facility
|
IP
|
$73.16
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Adventist Health Commercial |
$14.63
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Central Health Plan Commercial |
$58.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.26
|
| Rate for Payer: EPIC Health Plan Senior |
$29.26
|
| Rate for Payer: Galaxy Health WC |
$62.19
|
| Rate for Payer: Global Benefits Group Commercial |
$43.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.63
|
| Rate for Payer: Multiplan Commercial |
$54.87
|
| Rate for Payer: Networks By Design Commercial |
$47.55
|
| Rate for Payer: Prime Health Services Commercial |
$62.19
|
|
|
HC SOM OXALATE PLASMA
|
Facility
|
OP
|
$73.16
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
900910579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Adventist Health Commercial |
$14.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.45
|
| 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 |
$46.09
|
| Rate for Payer: Blue Shield of California EPN |
$29.04
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Central Health Plan Commercial |
$58.53
|
| Rate for Payer: Cigna of CA HMO |
$46.82
|
| Rate for Payer: Cigna of CA PPO |
$54.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.84
|
| Rate for Payer: EPIC Health Plan Senior |
$15.89
|
| Rate for Payer: Galaxy Health WC |
$62.19
|
| Rate for Payer: Global Benefits Group Commercial |
$43.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.36
|
| Rate for Payer: Multiplan Commercial |
$54.87
|
| Rate for Payer: Networks By Design Commercial |
$47.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.19
|
| Rate for Payer: Prime Health Services Medicare |
$15.32
|
| Rate for Payer: Riverside University Health System MISP |
$15.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$14.45
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$94.37 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.62
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.86
|
| Rate for Payer: EPIC Health Plan Senior |
$14.57
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Riverside University Health System MISP |
$14.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
900912537
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM PANCREATIC ELASTASE/STOOL
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
900912993
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
|
