|
HC SOM AMINO ACID QUANT UR RANDOM
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| 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 AMINO ACID QUANT UR RANDOM
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
900911210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$173.31 |
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.30
|
| 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 |
$173.31
|
| Rate for Payer: Blue Shield of California Commercial |
$34.58
|
| Rate for Payer: Blue Shield of California Commercial |
$52.27
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| 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 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 |
$173.31 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.30
|
| 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 |
$173.31
|
| Rate for Payer: Blue Shield of California Commercial |
$34.58
|
| Rate for Payer: Blue Shield of California Commercial |
$52.27
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.56
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.62
|
| 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 AMIODARONE
|
Facility
|
IP
|
$22.56
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$19.18 |
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$19.18
|
| Rate for Payer: Global Benefits Group Commercial |
$13.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| Rate for Payer: Multiplan Commercial |
$18.05
|
| Rate for Payer: Networks By Design Commercial |
$14.66
|
| Rate for Payer: Prime Health Services Commercial |
$19.18
|
|
|
HC SOM AMIODARONE
|
Facility
|
OP
|
$22.56
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$110.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Adventist Health Commercial |
$4.51
|
| 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 |
$68.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10.40
|
| Rate for Payer: Blue Shield of California Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cash Price |
$22.56
|
| Rate for Payer: Cigna of CA HMO |
$14.44
|
| Rate for Payer: Cigna of CA PPO |
$16.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$19.18
|
| Rate for Payer: Global Benefits Group Commercial |
$13.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$14.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.41
|
| 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 |
$18.05
|
| Rate for Payer: Networks By Design Commercial |
$14.66
|
| Rate for Payer: Prime Health Services Commercial |
$19.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.54
|
| 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
|
OP
|
$25.26
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Cigna of CA PPO |
$18.69
|
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| 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 |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$11.64
|
| Rate for Payer: Blue Shield of California Commercial |
$17.61
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Cigna of CA HMO |
$16.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| 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 |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.16
|
| 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
|
$25.26
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$21.47 |
| Rate for Payer: Adventist Health Commercial |
$5.05
|
| Rate for Payer: Cash Price |
$25.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$10.10
|
| Rate for Payer: Galaxy Health WC |
$21.47
|
| Rate for Payer: Global Benefits Group Commercial |
$15.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.06
|
| Rate for Payer: Multiplan Commercial |
$20.21
|
| Rate for Payer: Networks By Design Commercial |
$16.42
|
| Rate for Payer: Prime Health Services Commercial |
$21.47
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
IP
|
$148.31
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$126.06 |
| Rate for Payer: Adventist Health Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.32
|
| Rate for Payer: EPIC Health Plan Senior |
$59.32
|
| Rate for Payer: Galaxy Health WC |
$126.06
|
| Rate for Payer: Global Benefits Group Commercial |
$88.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$118.65
|
| Rate for Payer: Networks By Design Commercial |
$96.40
|
| Rate for Payer: Prime Health Services Commercial |
$126.06
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
OP
|
$148.31
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$29.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| 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 |
$150.30
|
| Rate for Payer: Blue Shield of California Commercial |
$103.37
|
| Rate for Payer: Blue Shield of California Commercial |
$68.37
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cigna of CA HMO |
$94.92
|
| Rate for Payer: Cigna of CA PPO |
$109.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$126.06
|
| Rate for Payer: Global Benefits Group Commercial |
$88.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.59
|
| 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 |
$118.65
|
| Rate for Payer: Networks By Design Commercial |
$96.40
|
| Rate for Payer: Prime Health Services Commercial |
$126.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.99
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.82
|
| 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 Foundation Hospitals Commercial/Self Funded |
$41.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.62
|
| 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 |
$0.07 |
| Max. Negotiated Rate |
$177.20 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| 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 |
$177.20
|
| Rate for Payer: Blue Shield of California Commercial |
$30.18
|
| Rate for Payer: Blue Shield of California Commercial |
$45.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.82
|
| 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 Foundation Hospitals Commercial/Self Funded |
$41.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.62
|
| 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
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$818.65 |
| Rate for Payer: Adventist Health Commercial |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$818.65
|
| Rate for Payer: Blue Shield of California Commercial |
$18.67
|
| Rate for Payer: Blue Shield of California Commercial |
$28.23
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$25.92
|
| Rate for Payer: Cigna of CA PPO |
$29.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.81
|
| Rate for Payer: EPIC Health Plan Senior |
$125.87
|
| Rate for Payer: Galaxy Health WC |
$34.42
|
| Rate for Payer: Global Benefits Group Commercial |
$24.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$187.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$107.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$114.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$144.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.34
|
| Rate for Payer: Multiplan Commercial |
$32.40
|
| Rate for Payer: Networks By Design Commercial |
$26.32
|
| Rate for Payer: Prime Health Services Commercial |
$34.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.69
|
| Rate for Payer: United Healthcare All Other HMO |
$92.69
|
| Rate for Payer: United Healthcare HMO Rider |
$92.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$114.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Vantage Medical Group Senior |
$114.43
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Adventist Health Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16.20
|
| Rate for Payer: Galaxy Health WC |
$34.42
|
| Rate for Payer: Global Benefits Group Commercial |
$24.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.72
|
| Rate for Payer: Multiplan Commercial |
$32.40
|
| Rate for Payer: Networks By Design Commercial |
$26.32
|
| Rate for Payer: Prime Health Services Commercial |
$34.42
|
|
|
HC SOM AMYLASE BF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$66.99 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.99
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| 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 |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| 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 |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC SOM AMYLASE BF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| 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 ANDROSTENEDIONE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$302.07 |
| Rate for Payer: Adventist Health Commercial |
$4.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.07
|
| Rate for Payer: Blue Shield of California Commercial |
$14.41
|
| Rate for Payer: Blue Shield of California Commercial |
$9.53
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cigna of CA HMO |
$13.24
|
| Rate for Payer: Cigna of CA PPO |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.21
|
| Rate for Payer: Galaxy Health WC |
$17.58
|
| Rate for Payer: Global Benefits Group Commercial |
$12.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$16.54
|
| Rate for Payer: Networks By Design Commercial |
$13.44
|
| Rate for Payer: Prime Health Services Commercial |
$17.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.71
|
| Rate for Payer: United Healthcare All Other HMO |
$23.71
|
| Rate for Payer: United Healthcare HMO Rider |
$23.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$17.58 |
| Rate for Payer: Adventist Health Commercial |
$4.14
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.27
|
| Rate for Payer: EPIC Health Plan Senior |
$8.27
|
| Rate for Payer: Galaxy Health WC |
$17.58
|
| Rate for Payer: Global Benefits Group Commercial |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$16.54
|
| Rate for Payer: Networks By Design Commercial |
$13.44
|
| Rate for Payer: Prime Health Services Commercial |
$17.58
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$150.65 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.65
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.09
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
OP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$150.65 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.65
|
| Rate for Payer: Blue Shield of California Commercial |
$31.58
|
| Rate for Payer: Blue Shield of California Commercial |
$47.74
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cigna of CA HMO |
$43.84
|
| Rate for Payer: Cigna of CA PPO |
$50.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.09
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$58.23
|
| Rate for Payer: Global Benefits Group Commercial |
$41.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$54.80
|
| Rate for Payer: Networks By Design Commercial |
$44.52
|
| Rate for Payer: Prime Health Services Commercial |
$58.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
IP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$58.23 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$58.23
|
| Rate for Payer: Global Benefits Group Commercial |
$41.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.44
|
| Rate for Payer: Multiplan Commercial |
$54.80
|
| Rate for Payer: Networks By Design Commercial |
$44.52
|
| Rate for Payer: Prime Health Services Commercial |
$58.23
|
|
|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$351.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$282.26
|
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.68
|
| Rate for Payer: Blue Shield of California Commercial |
$41.49
|
| Rate for Payer: Blue Shield of California Commercial |
$62.73
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$37.33
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$55.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.48
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.50
|
| Rate for Payer: United Healthcare All Other HMO |
$27.50
|
| Rate for Payer: United Healthcare HMO Rider |
$27.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Vantage Medical Group Senior |
$33.94
|
|
|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC SOM ANTI-GBM TITER AB
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Adventist Health Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.22
|
| Rate for Payer: EPIC Health Plan Senior |
$12.22
|
| Rate for Payer: Galaxy Health WC |
$25.97
|
| Rate for Payer: Global Benefits Group Commercial |
$18.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$24.44
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$25.97
|
|
