|
HC SOM ALPHA-1-ANTITRYPSIN, STOOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
900910858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 |
$20.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.14
|
| Rate for Payer: EPIC Health Plan Senior |
$13.44
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| 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 |
$10.89
|
| Rate for Payer: United Healthcare All Other HMO |
$10.89
|
| Rate for Payer: United Healthcare HMO Rider |
$10.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.78
|
| Rate for Payer: Vantage Medical Group Senior |
$13.44
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$134.46 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.46
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC SOM ALPHA-2-MACROGLOBULIN
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911487
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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: 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 |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM ALPHA-FETOPROTEIN, AMNIOTIC FL
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
900910946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$165.71 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.71
|
| Rate for Payer: Blue Shield of California Commercial |
$23.41
|
| Rate for Payer: Blue Shield of California EPN |
$15.47
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$25.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.95
|
| Rate for Payer: EPIC Health Plan Senior |
$17.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.78
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| 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 |
$13.77
|
| Rate for Payer: United Healthcare All Other HMO |
$13.77
|
| Rate for Payer: United Healthcare HMO Rider |
$13.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM ALPHA FETOPROTEIN CSF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900910585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$205.54 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.54
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$167.25
|
| Rate for Payer: Blue Shield of California EPN |
$110.50
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna of CA HMO |
$160.00
|
| Rate for Payer: Cigna of CA PPO |
$185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM ALPHA GALACTOSIDASE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900910718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC SOM ALUMINUM
|
Facility
|
IP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$16.99 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$15.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
|
|
HC SOM ALUMINUM
|
Facility
|
OP
|
$19.99
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
900911262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.69
|
| Rate for Payer: Blue Shield of California Commercial |
$13.37
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cash Price |
$19.99
|
| Rate for Payer: Cigna of CA HMO |
$12.79
|
| Rate for Payer: Cigna of CA PPO |
$14.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$25.48
|
| Rate for Payer: Galaxy Health WC |
$16.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.14
|
| Rate for Payer: Multiplan Commercial |
$15.99
|
| Rate for Payer: Networks By Design Commercial |
$12.99
|
| Rate for Payer: Prime Health Services Commercial |
$16.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.64
|
| Rate for Payer: United Healthcare All Other HMO |
$20.64
|
| Rate for Payer: United Healthcare HMO Rider |
$20.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.03
|
| Rate for Payer: Vantage Medical Group Senior |
$25.48
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$121.16 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.16
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.73
|
| Rate for Payer: EPIC Health Plan Senior |
$12.39
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.04
|
| Rate for Payer: United Healthcare All Other HMO |
$10.04
|
| Rate for Payer: United Healthcare HMO Rider |
$10.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.63
|
| Rate for Payer: Vantage Medical Group Senior |
$12.39
|
|
|
HC SOM AMEBIASIS AB TITER
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
900911754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM AMINO ACID QUANT UR RANDOM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$165.84 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| 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 HMO/PPO |
$165.84
|
| Rate for Payer: Blue Shield of California Commercial |
$66.90
|
| Rate for Payer: Blue Shield of California EPN |
$44.20
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| 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 |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| 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 |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| 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 AMINO ACID QUANT UR RANDOM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM AMINO ACIDS PLASMA
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$165.84 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| 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 HMO/PPO |
$165.84
|
| Rate for Payer: Blue Shield of California Commercial |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$33.15
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| 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 |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| 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 |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| 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 AMINO ACIDS PLASMA
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900910486
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$63.75 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM AMIODARONE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM AMIODARONE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$65.17 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| 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 HMO/PPO |
$65.17
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 AMITRIPTYLINE LEVEL
|
Facility
|
IP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$199.61 |
| Rate for Payer: Adventist Health Commercial |
$46.97
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.93
|
| Rate for Payer: EPIC Health Plan Senior |
$93.93
|
| Rate for Payer: Galaxy Health WC |
$199.61
|
| Rate for Payer: Global Benefits Group Commercial |
$140.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.36
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: Networks By Design Commercial |
$152.64
|
| Rate for Payer: Prime Health Services Commercial |
$199.61
|
|
|
HC SOM AMITRIPTYLINE LEVEL
|
Facility
|
OP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$199.61 |
| Rate for Payer: Adventist Health Commercial |
$46.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$154.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.57
|
| Rate for Payer: Blue Shield of California Commercial |
$157.10
|
| Rate for Payer: Blue Shield of California EPN |
$103.79
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Cigna of CA HMO |
$150.29
|
| Rate for Payer: Cigna of CA PPO |
$173.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.93
|
| Rate for Payer: EPIC Health Plan Senior |
$93.93
|
| Rate for Payer: Galaxy Health WC |
$199.61
|
| Rate for Payer: Global Benefits Group Commercial |
$140.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.38
|
| Rate for Payer: Multiplan Commercial |
$187.86
|
| Rate for Payer: Networks By Design Commercial |
$152.64
|
| Rate for Payer: Prime Health Services Commercial |
$199.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.42
|
| Rate for Payer: United Healthcare All Other HMO |
$117.42
|
| Rate for Payer: United Healthcare HMO Rider |
$117.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.61
|
| Rate for Payer: Vantage Medical Group Senior |
$199.61
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
OP
|
$285.90
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$243.01 |
| Rate for Payer: Adventist Health Commercial |
$57.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$187.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$214.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.52
|
| Rate for Payer: Blue Shield of California Commercial |
$191.27
|
| Rate for Payer: Blue Shield of California EPN |
$126.37
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna of CA HMO |
$182.98
|
| Rate for Payer: Cigna of CA PPO |
$211.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.36
|
| Rate for Payer: EPIC Health Plan Senior |
$114.36
|
| Rate for Payer: Galaxy Health WC |
$243.01
|
| Rate for Payer: Global Benefits Group Commercial |
$171.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.13
|
| Rate for Payer: Multiplan Commercial |
$228.72
|
| Rate for Payer: Networks By Design Commercial |
$185.84
|
| Rate for Payer: Prime Health Services Commercial |
$243.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.95
|
| Rate for Payer: United Healthcare All Other HMO |
$142.95
|
| Rate for Payer: United Healthcare HMO Rider |
$142.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.01
|
| Rate for Payer: Vantage Medical Group Senior |
$243.01
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
IP
|
$285.90
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$243.01 |
| Rate for Payer: Adventist Health Commercial |
$57.18
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.36
|
| Rate for Payer: EPIC Health Plan Senior |
$114.36
|
| Rate for Payer: Galaxy Health WC |
$243.01
|
| Rate for Payer: Global Benefits Group Commercial |
$171.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.62
|
| Rate for Payer: Multiplan Commercial |
$228.72
|
| Rate for Payer: Networks By Design Commercial |
$185.84
|
| Rate for Payer: Prime Health Services Commercial |
$243.01
|
|
|
HC SOM AMOXAPINE
|
Facility
|
IP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$55.64 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.71
|
| Rate for Payer: Multiplan Commercial |
$52.37
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
|
|
HC SOM AMOXAPINE
|
Facility
|
OP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$169.57 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.57
|
| Rate for Payer: Blue Shield of California Commercial |
$43.79
|
| Rate for Payer: Blue Shield of California EPN |
$28.93
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$48.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.82
|
| Rate for Payer: Multiplan Commercial |
$52.37
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.73
|
| Rate for Payer: United Healthcare All Other HMO |
$32.73
|
| Rate for Payer: United Healthcare HMO Rider |
$32.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.64
|
| Rate for Payer: Vantage Medical Group Senior |
$55.64
|
|
