|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$169.57 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.57
|
| Rate for Payer: Blue Shield of California Commercial |
$47.00
|
| Rate for Payer: Blue Shield of California EPN |
$31.05
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cigna of CA HMO |
$44.96
|
| Rate for Payer: Cigna of CA PPO |
$51.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$56.20
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.12
|
| Rate for Payer: United Healthcare HMO Rider |
$35.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$59.71 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$56.20
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
|
|
HC SOM DHEA
|
Facility
|
IP
|
$18.58
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.43
|
| Rate for Payer: EPIC Health Plan Senior |
$7.43
|
| Rate for Payer: Galaxy Health WC |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: Prime Health Services Commercial |
$15.79
|
|
|
HC SOM DHEA
|
Facility
|
OP
|
$18.58
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$249.63 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.63
|
| Rate for Payer: Blue Shield of California Commercial |
$12.43
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cigna of CA HMO |
$11.89
|
| Rate for Payer: Cigna of CA PPO |
$13.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Senior |
$25.27
|
| Rate for Payer: Galaxy Health WC |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: Prime Health Services Commercial |
$15.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.47
|
| Rate for Payer: United Healthcare All Other HMO |
$20.47
|
| Rate for Payer: United Healthcare HMO Rider |
$20.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
IP
|
$266.68
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$226.68 |
| Rate for Payer: Adventist Health Commercial |
$53.34
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.67
|
| Rate for Payer: EPIC Health Plan Senior |
$106.67
|
| Rate for Payer: Galaxy Health WC |
$226.68
|
| Rate for Payer: Global Benefits Group Commercial |
$160.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Multiplan Commercial |
$213.34
|
| Rate for Payer: Networks By Design Commercial |
$173.34
|
| Rate for Payer: Prime Health Services Commercial |
$226.68
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
OP
|
$266.68
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$226.68 |
| Rate for Payer: Adventist Health Commercial |
$53.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.22
|
| Rate for Payer: Blue Shield of California Commercial |
$178.41
|
| Rate for Payer: Blue Shield of California EPN |
$117.87
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cigna of CA HMO |
$170.68
|
| Rate for Payer: Cigna of CA PPO |
$197.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.67
|
| Rate for Payer: EPIC Health Plan Senior |
$106.67
|
| Rate for Payer: Galaxy Health WC |
$226.68
|
| Rate for Payer: Global Benefits Group Commercial |
$160.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.68
|
| Rate for Payer: Multiplan Commercial |
$213.34
|
| Rate for Payer: Networks By Design Commercial |
$173.34
|
| Rate for Payer: Prime Health Services Commercial |
$226.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.34
|
| Rate for Payer: United Healthcare All Other HMO |
$133.34
|
| Rate for Payer: United Healthcare HMO Rider |
$133.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.68
|
| Rate for Payer: Vantage Medical Group Senior |
$226.68
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$199.76 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| 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 |
$199.76
|
| Rate for Payer: Blue Shield of California Commercial |
$27.43
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| 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: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Senior |
$29.28
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| 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 |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| 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 DIHYDROTESTERONE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$138.45 |
| 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 |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.45
|
| 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 |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.76
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.44
|
| 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 |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$13.76
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| 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
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| 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
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$130.93 |
| 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 |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.93
|
| 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 |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| 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 |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| 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 DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$148.09 |
| 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 |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.09
|
| 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 |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| 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 |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$312.54 |
| 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 |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.54
|
| 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 |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: EPIC Health Plan Senior |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| 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 |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DNA AND RNA EXTRACT AND HOLD
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900915521
|
|
Hospital Revenue Code
|
300
|
| 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 DNA EXTRACTION
|
Facility
|
OP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$312.54 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$312.54
|
| Rate for Payer: Blue Shield of California Commercial |
$136.22
|
| Rate for Payer: Blue Shield of California EPN |
$90.00
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: Cigna of CA HMO |
$130.31
|
| Rate for Payer: Cigna of CA PPO |
$150.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: EPIC Health Plan Senior |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$162.89
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM DNA EXTRACTION
|
Facility
|
IP
|
$203.61
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
900910721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$173.07 |
| Rate for Payer: Adventist Health Commercial |
$40.72
|
| Rate for Payer: Cash Price |
$203.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.44
|
| Rate for Payer: EPIC Health Plan Senior |
$81.44
|
| Rate for Payer: Galaxy Health WC |
$173.07
|
| Rate for Payer: Global Benefits Group Commercial |
$122.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$135.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.87
|
| Rate for Payer: Multiplan Commercial |
$162.89
|
| Rate for Payer: Networks By Design Commercial |
$132.35
|
| Rate for Payer: Prime Health Services Commercial |
$173.07
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
OP
|
$47.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Adventist Health Commercial |
$9.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.65
|
| Rate for Payer: Blue Shield of California Commercial |
$32.08
|
| Rate for Payer: Blue Shield of California EPN |
$21.19
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Cigna of CA HMO |
$30.69
|
| Rate for Payer: Cigna of CA PPO |
$35.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$40.76
|
| Rate for Payer: Global Benefits Group Commercial |
$28.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$38.36
|
| Rate for Payer: Networks By Design Commercial |
$31.17
|
| Rate for Payer: Prime Health Services Commercial |
$40.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DRUG SCREEN PRESCRIPTION/OTC U
|
Facility
|
IP
|
$47.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Adventist Health Commercial |
$9.59
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.18
|
| Rate for Payer: EPIC Health Plan Senior |
$19.18
|
| Rate for Payer: Galaxy Health WC |
$40.76
|
| Rate for Payer: Global Benefits Group Commercial |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.51
|
| Rate for Payer: Multiplan Commercial |
$38.36
|
| Rate for Payer: Networks By Design Commercial |
$31.17
|
| Rate for Payer: Prime Health Services Commercial |
$40.76
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.65
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM DRUG SCRN MECONIUM AMPHETAMINE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900911008
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM DULOX 80299
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.93
|
| 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 |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$30.53
|
| Rate for Payer: Blue Shield of California EPN |
$20.17
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: Cigna of CA HMO |
$29.20
|
| Rate for Payer: Cigna of CA PPO |
$33.77
|
| 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 |
$38.79
|
| Rate for Payer: Global Benefits Group Commercial |
$27.38
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 Permanente of CA Commercial/Self Funded |
$30.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.95
|
| 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 |
$36.50
|
| Rate for Payer: Networks By Design Commercial |
$29.66
|
| Rate for Payer: Prime Health Services Commercial |
$38.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.38
|
| 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 DULOX 80299
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900914748
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$38.79 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$45.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.25
|
| Rate for Payer: EPIC Health Plan Senior |
$18.25
|
| Rate for Payer: Galaxy Health WC |
$38.79
|
| Rate for Payer: Global Benefits Group Commercial |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$36.50
|
| Rate for Payer: Networks By Design Commercial |
$29.66
|
| Rate for Payer: Prime Health Services Commercial |
$38.79
|
|
|
HC SOM EBV PCR QUANT
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900911395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
