|
HC SOM 8INHE FACTOR VIII INHIB TECH INTERP
|
Facility
|
OP
|
$23.19
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900911120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$37.52 |
| Rate for Payer: Adventist Health Commercial |
$4.64
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.61
|
| Rate for Payer: Blue Shield of California Commercial |
$14.08
|
| Rate for Payer: Blue Shield of California EPN |
$9.21
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Cash Price |
$23.19
|
| Rate for Payer: Central Health Plan Commercial |
$18.55
|
| Rate for Payer: Cigna of CA HMO |
$14.84
|
| Rate for Payer: Cigna of CA PPO |
$17.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$19.71
|
| Rate for Payer: Global Benefits Group Commercial |
$13.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: InnovAge PACE Commercial |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$17.39
|
| Rate for Payer: Networks By Design Commercial |
$15.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$19.71
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
IP
|
$27.58
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Central Health Plan Commercial |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Senior |
$11.03
|
| Rate for Payer: Galaxy Health WC |
$23.44
|
| Rate for Payer: Global Benefits Group Commercial |
$16.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$20.68
|
| Rate for Payer: Networks By Design Commercial |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$23.44
|
|
|
HC SOM 9INHE FACTOR IX ACTIVITY ASSAY
|
Facility
|
OP
|
$27.58
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
900915513
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$138.51 |
| Rate for Payer: Adventist Health Commercial |
$5.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.11
|
| Rate for Payer: Blue Shield of California Commercial |
$16.74
|
| Rate for Payer: Blue Shield of California EPN |
$10.95
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Central Health Plan Commercial |
$22.06
|
| Rate for Payer: Cigna of CA HMO |
$17.65
|
| Rate for Payer: Cigna of CA PPO |
$20.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.70
|
| Rate for Payer: EPIC Health Plan Senior |
$19.04
|
| Rate for Payer: Galaxy Health WC |
$23.44
|
| Rate for Payer: Global Benefits Group Commercial |
$16.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.04
|
| Rate for Payer: InnovAge PACE Commercial |
$28.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.51
|
| Rate for Payer: Multiplan Commercial |
$20.68
|
| Rate for Payer: Networks By Design Commercial |
$17.93
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.04
|
| Rate for Payer: Prime Health Services Commercial |
$23.44
|
| Rate for Payer: Prime Health Services Medicare |
$20.18
|
| Rate for Payer: Riverside University Health System MISP |
$20.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.43
|
| Rate for Payer: United Healthcare All Other HMO |
$15.43
|
| Rate for Payer: United Healthcare HMO Rider |
$15.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.94
|
| Rate for Payer: Vantage Medical Group Senior |
$19.04
|
|
|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
IP
|
$22.42
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$20.18 |
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Central Health Plan Commercial |
$17.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.97
|
| Rate for Payer: EPIC Health Plan Senior |
$8.97
|
| Rate for Payer: Galaxy Health WC |
$19.06
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$16.82
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: Prime Health Services Commercial |
$19.06
|
|
|
HC SOM 9INHE FACTOR IX INHIB TECH INTERP
|
Facility
|
OP
|
$22.42
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$37.52 |
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.61
|
| Rate for Payer: Blue Shield of California EPN |
$8.90
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Central Health Plan Commercial |
$17.94
|
| Rate for Payer: Cigna of CA HMO |
$14.35
|
| Rate for Payer: Cigna of CA PPO |
$16.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$19.06
|
| Rate for Payer: Global Benefits Group Commercial |
$13.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: InnovAge PACE Commercial |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$16.82
|
| Rate for Payer: Networks By Design Commercial |
$14.57
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$19.06
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
OP
|
$39.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$98.30 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.14
|
| 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 |
$19.95
|
| Rate for Payer: Blue Shield of California Commercial |
$24.13
|
| Rate for Payer: Blue Shield of California EPN |
$15.78
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.80
|
| Rate for Payer: Cigna of CA HMO |
$25.44
|
| Rate for Payer: Cigna of CA PPO |
$29.41
|
| 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: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$33.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.77
|
| 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: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$29.81
|
| Rate for Payer: Networks By Design Commercial |
$25.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$33.79
|
| 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 |
$23.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.85
|
| 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 ACETYLCHOLINE RECPT AB BINDING
|
Facility
|
IP
|
$39.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.90
|
| Rate for Payer: Galaxy Health WC |
$33.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$29.81
|
| Rate for Payer: Networks By Design Commercial |
$25.84
|
| Rate for Payer: Prime Health Services Commercial |
$33.79
|
|
|
HC SOM ACETYLCHOLINESTERASE
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC SOM ACETYLCHOLINESTERASE
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
900910948
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$55.88 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.34
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.24
|
| Rate for Payer: EPIC Health Plan Senior |
$9.81
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.81
|
| Rate for Payer: InnovAge PACE Commercial |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.81
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$10.40
|
| Rate for Payer: Riverside University Health System MISP |
$10.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.95
|
| Rate for Payer: United Healthcare All Other HMO |
$7.95
|
| Rate for Payer: United Healthcare HMO Rider |
$7.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.79
|
| Rate for Payer: Vantage Medical Group Senior |
$9.81
|
|
|
HC SOM ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$39.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$98.30 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.14
|
| 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 |
$19.95
|
| Rate for Payer: Blue Shield of California Commercial |
$24.13
|
| Rate for Payer: Blue Shield of California EPN |
$15.78
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.80
|
| Rate for Payer: Cigna of CA HMO |
$25.44
|
| Rate for Payer: Cigna of CA PPO |
$29.41
|
| 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: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$33.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.77
|
| 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: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$29.81
|
| Rate for Payer: Networks By Design Commercial |
$25.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$33.79
|
| 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 |
$23.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.85
|
| 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 ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$39.75
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900912583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$39.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.90
|
| Rate for Payer: Galaxy Health WC |
$33.79
|
| Rate for Payer: Global Benefits Group Commercial |
$23.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$29.81
|
| Rate for Payer: Networks By Design Commercial |
$25.84
|
| Rate for Payer: Prime Health Services Commercial |
$33.79
|
|
|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
|
OP
|
$186.60
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$167.94 |
| Rate for Payer: Adventist Health Commercial |
$37.32
|
| Rate for Payer: Adventist Health Medi-Cal |
$9.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.28
|
| Rate for Payer: Blue Shield of California Commercial |
$113.27
|
| Rate for Payer: Blue Shield of California EPN |
$74.08
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Central Health Plan Commercial |
$149.28
|
| Rate for Payer: Cigna of CA HMO |
$119.42
|
| Rate for Payer: Cigna of CA PPO |
$138.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.04
|
| Rate for Payer: EPIC Health Plan Senior |
$9.66
|
| Rate for Payer: Galaxy Health WC |
$158.61
|
| Rate for Payer: Global Benefits Group Commercial |
$111.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.66
|
| Rate for Payer: InnovAge PACE Commercial |
$14.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$139.95
|
| Rate for Payer: Networks By Design Commercial |
$121.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9.66
|
| Rate for Payer: Prime Health Services Commercial |
$158.61
|
| Rate for Payer: Prime Health Services Medicare |
$10.24
|
| Rate for Payer: Riverside University Health System MISP |
$10.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.82
|
| Rate for Payer: United Healthcare All Other HMO |
$7.82
|
| Rate for Payer: United Healthcare HMO Rider |
$7.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.63
|
| Rate for Payer: Vantage Medical Group Senior |
$9.66
|
|
|
HC SOM ACID PHOSPHATASE TOTAL
|
Facility
|
IP
|
$186.60
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
900910217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$167.94 |
| Rate for Payer: Adventist Health Commercial |
$37.32
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Central Health Plan Commercial |
$149.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.64
|
| Rate for Payer: EPIC Health Plan Senior |
$74.64
|
| Rate for Payer: Galaxy Health WC |
$158.61
|
| Rate for Payer: Global Benefits Group Commercial |
$111.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.32
|
| Rate for Payer: Multiplan Commercial |
$139.95
|
| Rate for Payer: Networks By Design Commercial |
$121.29
|
| Rate for Payer: Prime Health Services Commercial |
$158.61
|
|
|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.61
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.32
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.32
|
| Rate for Payer: InnovAge PACE Commercial |
$22.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.53
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.32
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.24
|
| Rate for Payer: Riverside University Health System MISP |
$16.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.41
|
| Rate for Payer: United Healthcare All Other HMO |
$12.41
|
| Rate for Payer: United Healthcare HMO Rider |
$12.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.85
|
| Rate for Payer: Vantage Medical Group Senior |
$15.32
|
|
|
HC SOM ACTIVATED PROTEIN C RESISTANCE
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
900912508
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Central Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Senior |
$65.60
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$101.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
|
|
HC SOM ACYCLOVIR
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.50
|
| Rate for Payer: Blue Shield of California Commercial |
$99.55
|
| Rate for Payer: Blue Shield of California EPN |
$65.11
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Central Health Plan Commercial |
$131.20
|
| Rate for Payer: Cigna of CA HMO |
$104.96
|
| Rate for Payer: Cigna of CA PPO |
$121.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$139.40
|
| Rate for Payer: Global Benefits Group Commercial |
$98.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$123.00
|
| Rate for Payer: Networks By Design Commercial |
$106.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$139.40
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
IP
|
$41.20
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$37.08 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Central Health Plan Commercial |
$32.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.48
|
| Rate for Payer: EPIC Health Plan Senior |
$16.48
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.24
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
|
|
HC SOM ACYLCARNITINE PROFILE(PKU CARD
|
Facility
|
OP
|
$41.20
|
|
|
Service Code
|
CPT 82017
|
| Hospital Charge Code |
900911486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$122.15 |
| Rate for Payer: Adventist Health Commercial |
$8.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.79
|
| Rate for Payer: Blue Shield of California Commercial |
$25.01
|
| Rate for Payer: Blue Shield of California EPN |
$16.36
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Central Health Plan Commercial |
$32.96
|
| Rate for Payer: Cigna of CA HMO |
$26.37
|
| Rate for Payer: Cigna of CA PPO |
$30.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.77
|
| Rate for Payer: EPIC Health Plan Senior |
$16.87
|
| Rate for Payer: Galaxy Health WC |
$35.02
|
| Rate for Payer: Global Benefits Group Commercial |
$24.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: InnovAge PACE Commercial |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$26.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.87
|
| Rate for Payer: Prime Health Services Commercial |
$35.02
|
| Rate for Payer: Prime Health Services Medicare |
$17.88
|
| Rate for Payer: Riverside University Health System MISP |
$18.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.66
|
| Rate for Payer: United Healthcare All Other HMO |
$13.66
|
| Rate for Payer: United Healthcare HMO Rider |
$13.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.56
|
| Rate for Payer: Vantage Medical Group Senior |
$16.87
|
|
|
HC SOM ACYLGLYCINE
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM ACYLGLYCINE
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900910712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.28
|
| 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 |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$106.22
|
| Rate for Payer: Blue Shield of California EPN |
$69.47
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| 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: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| 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: InnovAge PACE Commercial |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| 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 |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| 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 ADALIMUMAB AB
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM ADALIMUMAB AB
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.86
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Senior |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: InnovAge PACE Commercial |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.12
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Riverside University Health System MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SOM ADALIMUMAB AB REFLEX
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| 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 |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| 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: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| 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: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| 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 |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| 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
|
|
