|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM FISH NEWBORN ANEUPLOIDY DETECT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910685
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
|
|
HC SOM FISH PRENATAL ANEUPLOIDY DETEC
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910689
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$150.53
|
| Rate for Payer: Blue Shield of California EPN |
$99.45
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Senior |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC SOM FISH UROTHELIAL CANCER
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$2,863.23 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,863.23
|
| Rate for Payer: Blue Shield of California Commercial |
$294.36
|
| Rate for Payer: Blue Shield of California EPN |
$194.48
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna of CA HMO |
$281.60
|
| Rate for Payer: Cigna of CA PPO |
$325.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$610.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC SOM FISH UROTHELIAL CANCER
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$176.00
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
|
|
HC SOM FLECAINIDE ACETATE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
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 FLECAINIDE ACETATE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$65.17 |
| 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 |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.17
|
| Rate for Payer: Blue Shield of California Commercial |
$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 |
$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 |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| 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 |
$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 |
$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 FLEXERIL
|
Facility
|
OP
|
$69.57
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$166.97 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.97
|
| Rate for Payer: Blue Shield of California Commercial |
$46.54
|
| Rate for Payer: Blue Shield of California EPN |
$30.75
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cigna of CA HMO |
$44.52
|
| Rate for Payer: Cigna of CA PPO |
$51.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.83
|
| Rate for Payer: EPIC Health Plan Senior |
$27.83
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.70
|
| Rate for Payer: Multiplan Commercial |
$55.66
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.78
|
| Rate for Payer: United Healthcare All Other HMO |
$34.78
|
| Rate for Payer: United Healthcare HMO Rider |
$34.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.13
|
| Rate for Payer: Vantage Medical Group Senior |
$59.13
|
|
|
HC SOM FLEXERIL
|
Facility
|
IP
|
$69.57
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$59.13 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.83
|
| Rate for Payer: EPIC Health Plan Senior |
$27.83
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$55.66
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
|
OP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$32.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$108.71
|
| Rate for Payer: Blue Shield of California EPN |
$71.83
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna of CA HMO |
$104.00
|
| Rate for Payer: Cigna of CA PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$138.12
|
| Rate for Payer: Global Benefits Group Commercial |
$97.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$130.00
|
| Rate for Payer: Networks By Design Commercial |
$105.62
|
| Rate for Payer: Prime Health Services Commercial |
$138.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
|
IP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$138.12 |
| Rate for Payer: Adventist Health Commercial |
$32.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: EPIC Health Plan Senior |
$65.00
|
| Rate for Payer: Galaxy Health WC |
$138.12
|
| Rate for Payer: Global Benefits Group Commercial |
$97.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$130.00
|
| Rate for Payer: Networks By Design Commercial |
$105.62
|
| Rate for Payer: Prime Health Services Commercial |
$138.12
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$618.89 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$618.89
|
| Rate for Payer: Blue Shield of California Commercial |
$110.39
|
| Rate for Payer: Blue Shield of California EPN |
$72.93
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.44
|
| Rate for Payer: EPIC Health Plan Senior |
$165.51
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$271.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.78
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.06
|
| Rate for Payer: United Healthcare All Other HMO |
$134.06
|
| Rate for Payer: United Healthcare HMO Rider |
$134.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: Vantage Medical Group Senior |
$165.51
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
|
OP
|
$263.80
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$224.23 |
| Rate for Payer: Adventist Health Commercial |
$52.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.13
|
| Rate for Payer: Blue Shield of California Commercial |
$176.48
|
| Rate for Payer: Blue Shield of California EPN |
$116.60
|
| Rate for Payer: Cash Price |
$263.80
|
| Rate for Payer: Cash Price |
$263.80
|
| Rate for Payer: Cigna of CA HMO |
$168.83
|
| Rate for Payer: Cigna of CA PPO |
$195.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.54
|
| Rate for Payer: Galaxy Health WC |
$224.23
|
| Rate for Payer: Global Benefits Group Commercial |
$158.28
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$211.04
|
| Rate for Payer: Networks By Design Commercial |
$171.47
|
| Rate for Payer: Prime Health Services Commercial |
$224.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.02
|
| Rate for Payer: United Healthcare All Other HMO |
$15.02
|
| Rate for Payer: United Healthcare HMO Rider |
$15.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
|
IP
|
$263.80
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$224.23 |
| Rate for Payer: Adventist Health Commercial |
$52.76
|
| Rate for Payer: Cash Price |
$263.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.52
|
| Rate for Payer: EPIC Health Plan Senior |
$105.52
|
| Rate for Payer: Galaxy Health WC |
$224.23
|
| Rate for Payer: Global Benefits Group Commercial |
$158.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.31
|
| Rate for Payer: Multiplan Commercial |
$211.04
|
| Rate for Payer: Networks By Design Commercial |
$171.47
|
| Rate for Payer: Prime Health Services Commercial |
$224.23
|
|
|
HC SOM FLUOXETINE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM FLUOXETINE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.07
|
| 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 |
$36.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| 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 |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| 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 |
$36.69
|
| 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 |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM FLUPHENAZINE
|
Facility
|
OP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$147.56 |
| Rate for Payer: Adventist Health Commercial |
$17.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.56
|
| Rate for Payer: Blue Shield of California Commercial |
$57.29
|
| Rate for Payer: Blue Shield of California EPN |
$37.85
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cigna of CA HMO |
$54.80
|
| Rate for Payer: Cigna of CA PPO |
$63.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.25
|
| Rate for Payer: EPIC Health Plan Senior |
$34.25
|
| Rate for Payer: Galaxy Health WC |
$72.79
|
| Rate for Payer: Global Benefits Group Commercial |
$51.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.94
|
| Rate for Payer: Multiplan Commercial |
$68.50
|
| Rate for Payer: Networks By Design Commercial |
$55.66
|
| Rate for Payer: Prime Health Services Commercial |
$72.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.81
|
| Rate for Payer: United Healthcare All Other HMO |
$42.81
|
| Rate for Payer: United Healthcare HMO Rider |
$42.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.79
|
| Rate for Payer: Vantage Medical Group Senior |
$72.79
|
|
|
HC SOM FLUPHENAZINE
|
Facility
|
IP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$72.79 |
| Rate for Payer: Adventist Health Commercial |
$17.13
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.25
|
| Rate for Payer: EPIC Health Plan Senior |
$34.25
|
| Rate for Payer: Galaxy Health WC |
$72.79
|
| Rate for Payer: Global Benefits Group Commercial |
$51.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.55
|
| Rate for Payer: Multiplan Commercial |
$68.50
|
| Rate for Payer: Networks By Design Commercial |
$55.66
|
| Rate for Payer: Prime Health Services Commercial |
$72.79
|
|
|
HC SOM FLURAZEPAM (DALMANE) LEVEL
|
Facility
|
IP
|
$67.52
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$57.39 |
| Rate for Payer: Adventist Health Commercial |
$13.50
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.01
|
| Rate for Payer: EPIC Health Plan Senior |
$27.01
|
| Rate for Payer: Galaxy Health WC |
$57.39
|
| Rate for Payer: Global Benefits Group Commercial |
$40.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$54.02
|
| Rate for Payer: Networks By Design Commercial |
$43.89
|
| Rate for Payer: Prime Health Services Commercial |
$57.39
|
|
|
HC SOM FLURAZEPAM (DALMANE) LEVEL
|
Facility
|
OP
|
$67.52
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$175.22 |
| Rate for Payer: Adventist Health Commercial |
$13.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.22
|
| Rate for Payer: Blue Shield of California Commercial |
$45.17
|
| Rate for Payer: Blue Shield of California EPN |
$29.84
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Cigna of CA HMO |
$43.21
|
| Rate for Payer: Cigna of CA PPO |
$49.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.01
|
| Rate for Payer: EPIC Health Plan Senior |
$27.01
|
| Rate for Payer: Galaxy Health WC |
$57.39
|
| Rate for Payer: Global Benefits Group Commercial |
$40.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.26
|
| Rate for Payer: Multiplan Commercial |
$54.02
|
| Rate for Payer: Networks By Design Commercial |
$43.89
|
| Rate for Payer: Prime Health Services Commercial |
$57.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.76
|
| Rate for Payer: United Healthcare All Other HMO |
$33.76
|
| Rate for Payer: United Healthcare HMO Rider |
$33.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.39
|
| Rate for Payer: Vantage Medical Group Senior |
$57.39
|
|
|
HC SOM FMGA 84181
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM FMGA 84181
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$168.24 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.24
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$55.25
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.99
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13.80
|
| Rate for Payer: United Healthcare HMO Rider |
$13.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM FMGS 83520A
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$73.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.62
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
