|
HC SOM MBCR 88291 SOM
|
Facility
|
IP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$22.26 |
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.29
|
| Rate for Payer: Multiplan Commercial |
$20.95
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
|
OP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: EPIC Health Plan Senior |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.52
|
| Rate for Payer: Blue Shield of California EPN |
$11.58
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$19.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$20.95
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.71
|
| 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 |
$22.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.26
|
| Rate for Payer: Vantage Medical Group Senior |
$22.26
|
|
|
HC SOM MCLON IFE U
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$137.45 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.45
|
| Rate for Payer: Blue Shield of California Commercial |
$19.31
|
| Rate for Payer: Blue Shield of California EPN |
$12.76
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cigna of CA HMO |
$18.47
|
| Rate for Payer: Cigna of CA PPO |
$21.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.62
|
| Rate for Payer: EPIC Health Plan Senior |
$29.35
|
| Rate for Payer: Galaxy Health WC |
$24.53
|
| Rate for Payer: Global Benefits Group Commercial |
$17.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$23.09
|
| Rate for Payer: Networks By Design Commercial |
$18.76
|
| Rate for Payer: Prime Health Services Commercial |
$24.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.78
|
| Rate for Payer: United Healthcare All Other HMO |
$23.78
|
| Rate for Payer: United Healthcare HMO Rider |
$23.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM MCLON IFE U
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$24.53 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.54
|
| Rate for Payer: EPIC Health Plan Senior |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$24.53
|
| Rate for Payer: Global Benefits Group Commercial |
$17.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.93
|
| Rate for Payer: Multiplan Commercial |
$23.09
|
| Rate for Payer: Networks By Design Commercial |
$18.76
|
| Rate for Payer: Prime Health Services Commercial |
$24.53
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$172.56 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.56
|
| Rate for Payer: Blue Shield of California Commercial |
$11.73
|
| Rate for Payer: Blue Shield of California EPN |
$7.75
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cigna of CA HMO |
$11.22
|
| Rate for Payer: Cigna of CA PPO |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Senior |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$14.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.21
|
| Rate for Payer: Multiplan Commercial |
$14.02
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.90
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.87
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.76
|
| 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 |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$15.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.95
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$14.40
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| 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: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| 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 |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| 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 MEASLES AB IGM CSF
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.76
|
| 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 |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$15.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.95
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$14.40
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| 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: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$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 Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.40
|
| 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 |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| 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 MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$147.29 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.29
|
| Rate for Payer: Blue Shield of California Commercial |
$23.47
|
| Rate for Payer: Blue Shield of California EPN |
$15.51
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cigna of CA HMO |
$22.45
|
| Rate for Payer: Cigna of CA PPO |
$25.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.03
|
| Rate for Payer: EPIC Health Plan Senior |
$14.03
|
| Rate for Payer: Galaxy Health WC |
$29.82
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.56
|
| Rate for Payer: Multiplan Commercial |
$28.06
|
| Rate for Payer: Networks By Design Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.54
|
| Rate for Payer: United Healthcare All Other HMO |
$17.54
|
| Rate for Payer: United Healthcare HMO Rider |
$17.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$29.82
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$29.82 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.03
|
| Rate for Payer: EPIC Health Plan Senior |
$14.03
|
| Rate for Payer: Galaxy Health WC |
$29.82
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$28.06
|
| Rate for Payer: Networks By Design Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$29.82
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
IP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.61 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.61
|
| Rate for Payer: Global Benefits Group Commercial |
$57.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.81
|
| Rate for Payer: Networks By Design Commercial |
$62.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.61
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
OP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$143.63 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.63
|
| Rate for Payer: Blue Shield of California Commercial |
$64.23
|
| Rate for Payer: Blue Shield of California EPN |
$42.44
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Cigna of CA HMO |
$61.45
|
| Rate for Payer: Cigna of CA PPO |
$71.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.61
|
| Rate for Payer: Global Benefits Group Commercial |
$57.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.21
|
| Rate for Payer: Multiplan Commercial |
$76.81
|
| Rate for Payer: Networks By Design Commercial |
$62.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.01
|
| Rate for Payer: United Healthcare All Other HMO |
$48.01
|
| Rate for Payer: United Healthcare HMO Rider |
$48.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.61
|
| Rate for Payer: Vantage Medical Group Senior |
$81.61
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
IP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: EPIC Health Plan Senior |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Multiplan Commercial |
$18.74
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
OP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$147.29 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.29
|
| Rate for Payer: Blue Shield of California Commercial |
$15.67
|
| Rate for Payer: Blue Shield of California EPN |
$10.35
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$17.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: EPIC Health Plan Senior |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$18.74
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.91
|
| Rate for Payer: Vantage Medical Group Senior |
$19.91
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
IP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$41.71 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: EPIC Health Plan Senior |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$39.26
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
OP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$184.33 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.33
|
| Rate for Payer: Blue Shield of California Commercial |
$32.83
|
| Rate for Payer: Blue Shield of California EPN |
$21.69
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cigna of CA HMO |
$31.40
|
| Rate for Payer: Cigna of CA PPO |
$36.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: EPIC Health Plan Senior |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.35
|
| Rate for Payer: Multiplan Commercial |
$39.26
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.54
|
| Rate for Payer: United Healthcare All Other HMO |
$24.54
|
| Rate for Payer: United Healthcare HMO Rider |
$24.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.71
|
| Rate for Payer: Vantage Medical Group Senior |
$41.71
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$120.42
|
| Rate for Payer: Blue Shield of California EPN |
$79.56
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$115.20
|
| Rate for Payer: Cigna of CA PPO |
$133.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$224.43 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.43
|
| Rate for Payer: Blue Shield of California Commercial |
$50.91
|
| Rate for Payer: Blue Shield of California EPN |
$33.64
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$60.88
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$64.69 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$60.88
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
|
|
HC SOM MENMS 81405
|
Facility
|
IP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$111.27 |
| Max. Negotiated Rate |
$472.90 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.54
|
| Rate for Payer: EPIC Health Plan Senior |
$222.54
|
| Rate for Payer: Galaxy Health WC |
$472.90
|
| Rate for Payer: Global Benefits Group Commercial |
$333.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$344.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.52
|
| Rate for Payer: Multiplan Commercial |
$445.08
|
| Rate for Payer: Networks By Design Commercial |
$361.63
|
| Rate for Payer: Prime Health Services Commercial |
$472.90
|
|
