|
HC SOM CYSTICERCOSIS AB CSF
|
Facility
|
OP
|
$122.89
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900911345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$135.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.18
|
| Rate for Payer: Adventist Health Commercial |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.50
|
| Rate for Payer: Blue Shield of California Commercial |
$56.65
|
| Rate for Payer: Blue Shield of California Commercial |
$85.65
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cash Price |
$122.89
|
| Rate for Payer: Cigna of CA HMO |
$78.65
|
| Rate for Payer: Cigna of CA PPO |
$90.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.47
|
| Rate for Payer: EPIC Health Plan Senior |
$14.31
|
| Rate for Payer: Galaxy Health WC |
$104.46
|
| Rate for Payer: Global Benefits Group Commercial |
$73.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$98.31
|
| Rate for Payer: Networks By Design Commercial |
$79.88
|
| Rate for Payer: Prime Health Services Commercial |
$104.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
OP
|
$167.47
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$4,375.58 |
| Rate for Payer: United Healthcare HMO Rider |
$450.85
|
| Rate for Payer: Adventist Health Commercial |
$33.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,405.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,375.58
|
| Rate for Payer: Blue Shield of California Commercial |
$116.73
|
| Rate for Payer: Blue Shield of California Commercial |
$77.20
|
| Rate for Payer: Cash Price |
$167.47
|
| Rate for Payer: Cash Price |
$167.47
|
| Rate for Payer: Cigna of CA HMO |
$107.18
|
| Rate for Payer: Cigna of CA PPO |
$123.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$834.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$918.39
|
| Rate for Payer: EPIC Health Plan Senior |
$612.26
|
| Rate for Payer: Galaxy Health WC |
$142.35
|
| Rate for Payer: Global Benefits Group Commercial |
$100.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$912.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$302.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$556.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$779.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$701.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$745.84
|
| Rate for Payer: Multiplan Commercial |
$133.98
|
| Rate for Payer: Networks By Design Commercial |
$108.86
|
| Rate for Payer: Prime Health Services Commercial |
$142.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.85
|
| Rate for Payer: United Healthcare All Other HMO |
$450.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$450.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$556.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$834.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Vantage Medical Group Senior |
$556.60
|
|
|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
|
IP
|
$167.47
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Adventist Health Commercial |
$33.49
|
| Rate for Payer: Cash Price |
$167.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.99
|
| Rate for Payer: EPIC Health Plan Senior |
$66.99
|
| Rate for Payer: Galaxy Health WC |
$142.35
|
| Rate for Payer: Global Benefits Group Commercial |
$100.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$133.98
|
| Rate for Payer: Networks By Design Commercial |
$108.86
|
| Rate for Payer: Prime Health Services Commercial |
$142.35
|
|
|
HC SOM CYSTIC FIBROSIS GENE MUTATION
|
Facility
|
OP
|
$130.90
|
|
|
Service Code
|
CPT 81222
|
| Hospital Charge Code |
900915427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$2,347.06 |
| Rate for Payer: EPIC Health Plan Senior |
$478.58
|
| Rate for Payer: Galaxy Health WC |
$111.27
|
| Rate for Payer: Global Benefits Group Commercial |
$78.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$713.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$730.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$435.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$826.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$609.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$548.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$582.99
|
| Rate for Payer: Multiplan Commercial |
$104.72
|
| Rate for Payer: Networks By Design Commercial |
$85.08
|
| Rate for Payer: Prime Health Services Commercial |
$111.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.40
|
| Rate for Payer: United Healthcare All Other HMO |
$352.40
|
| Rate for Payer: United Healthcare HMO Rider |
$352.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$435.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$652.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.58
|
| Rate for Payer: Vantage Medical Group Senior |
$435.07
|
| Rate for Payer: Adventist Health Commercial |
$26.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,347.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$652.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$478.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$739.71
|
| Rate for Payer: Blue Shield of California Commercial |
$60.34
|
| Rate for Payer: Blue Shield of California Commercial |
$91.24
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Cigna of CA HMO |
$83.78
|
| Rate for Payer: Cigna of CA PPO |
$96.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$652.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$435.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$717.87
|
|
|
HC SOM CYSTIC FIBROSIS GENE MUTATION
|
Facility
|
IP
|
$130.90
|
|
|
Service Code
|
CPT 81222
|
| Hospital Charge Code |
900915427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$111.27 |
| Rate for Payer: Adventist Health Commercial |
$26.18
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.36
|
| Rate for Payer: EPIC Health Plan Senior |
$52.36
|
| Rate for Payer: Galaxy Health WC |
$111.27
|
| Rate for Payer: Global Benefits Group Commercial |
$78.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.42
|
| Rate for Payer: Multiplan Commercial |
$104.72
|
| Rate for Payer: Networks By Design Commercial |
$85.08
|
| Rate for Payer: Prime Health Services Commercial |
$111.27
|
|
|
HC SOM DCP 83951
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| 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 DCP 83951
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$662.51 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$535.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$662.51
|
| 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 |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.28
|
| Rate for Payer: EPIC Health Plan Senior |
$70.85
|
| 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 |
$105.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.31
|
| 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 |
$52.17
|
| Rate for Payer: United Healthcare All Other HMO |
$52.17
|
| Rate for Payer: United Healthcare HMO Rider |
$52.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$64.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.38
|
| Rate for Payer: Multiplan Commercial |
$71.28
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.08
|
| Rate for Payer: Blue Shield of California Commercial |
$62.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO |
$57.02
|
| Rate for Payer: Cigna of CA PPO |
$65.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$71.28
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$41.08
|
| Rate for Payer: Blue Shield of California Commercial |
$62.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna of CA HMO |
$57.02
|
| Rate for Payer: Cigna of CA PPO |
$65.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$71.28
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$75.73 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.38
|
| Rate for Payer: Multiplan Commercial |
$71.28
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25.00
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$50.00
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Cigna of CA PPO |
$46.25
|
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$28.81
|
| Rate for Payer: Blue Shield of California Commercial |
$43.56
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna of CA HMO |
$40.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$50.00
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$241.47 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.47
|
| Rate for Payer: Blue Shield of California Commercial |
$28.81
|
| Rate for Payer: Blue Shield of California Commercial |
$43.56
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna of CA HMO |
$40.00
|
| Rate for Payer: Cigna of CA PPO |
$46.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$50.00
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$53.12 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25.00
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$50.00
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$177.20 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| 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 |
$177.20
|
| Rate for Payer: Blue Shield of California Commercial |
$32.39
|
| Rate for Payer: Blue Shield of California Commercial |
$48.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.17
|
| 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 Foundation Hospitals Commercial/Self Funded |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.45
|
| 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
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.17
|
| 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 |
$260.86
|
| Rate for Payer: Blue Shield of California Commercial |
$14.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9.68
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.70
|
| Rate for Payer: EPIC Health Plan Senior |
$27.80
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| 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 |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| 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 DHEA
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Senior |
$17.48
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$34.95
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$158.71 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.71
|
| Rate for Payer: Blue Shield of California Commercial |
$20.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.45
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cigna of CA HMO |
$27.96
|
| Rate for Payer: Cigna of CA PPO |
$32.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$34.95
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$37.14 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Senior |
$17.48
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Multiplan Commercial |
$34.95
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$158.71 |
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.71
|
| Rate for Payer: Blue Shield of California Commercial |
$20.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.45
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cigna of CA HMO |
$27.96
|
| Rate for Payer: Cigna of CA PPO |
$32.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$34.95
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$37.17 |
| Rate for Payer: Adventist Health Commercial |
$8.75
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.49
|
| Rate for Payer: EPIC Health Plan Senior |
$17.49
|
| Rate for Payer: Galaxy Health WC |
$37.17
|
| Rate for Payer: Global Benefits Group Commercial |
$26.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$34.98
|
| Rate for Payer: Networks By Design Commercial |
$28.42
|
| Rate for Payer: Prime Health Services Commercial |
$37.17
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
OP
|
$43.73
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$8.75
|
| 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 |
$20.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.48
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Cigna of CA HMO |
$27.99
|
| Rate for Payer: Cigna of CA PPO |
$32.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$37.17
|
| Rate for Payer: Global Benefits Group Commercial |
$26.24
|
| 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 |
$27.77
|
| 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 |
$10.50
|
| 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 |
$34.98
|
| Rate for Payer: Networks By Design Commercial |
$28.42
|
| Rate for Payer: Prime Health Services Commercial |
$37.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.24
|
| 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
|
|
