|
HC SOM ENS PDE10A IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915475
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENS SEPTIN7 IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
IP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.62
|
| Rate for Payer: EPIC Health Plan Senior |
$13.62
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
|
|
HC SOM ENS TRIM46 IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$23.74
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$27.25
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$354.39 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.39
|
| Rate for Payer: Blue Shield of California Commercial |
$20.75
|
| Rate for Payer: Blue Shield of California Commercial |
$31.36
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$354.39 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.39
|
| Rate for Payer: Blue Shield of California Commercial |
$20.75
|
| Rate for Payer: Blue Shield of California Commercial |
$31.36
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ERYTHROPOIETIN
|
Facility
|
IP
|
$15.68
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
900911227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$13.33 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Senior |
$6.27
|
| Rate for Payer: Galaxy Health WC |
$13.33
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Multiplan Commercial |
$12.54
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$13.33
|
|
|
HC SOM ERYTHROPOIETIN
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
900911227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$192.62 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$156.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.62
|
| Rate for Payer: Blue Shield of California Commercial |
$10.93
|
| Rate for Payer: Blue Shield of California Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cigna of CA HMO |
$10.04
|
| Rate for Payer: Cigna of CA PPO |
$11.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.67
|
| Rate for Payer: Galaxy Health WC |
$13.33
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.18
|
| Rate for Payer: Multiplan Commercial |
$12.54
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.22
|
| Rate for Payer: United Healthcare All Other HMO |
$15.22
|
| Rate for Payer: United Healthcare HMO Rider |
$15.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: Vantage Medical Group Senior |
$18.79
|
|
|
HC SOM ESTRADIOL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
900911014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM ESTRADIOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
900911014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$333.34 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$268.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.34
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: EPIC Health Plan Senior |
$35.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$52.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.28
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Other HMO |
$26.16
|
| Rate for Payer: United Healthcare HMO Rider |
$26.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.53
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC SOM ESTRIOL
|
Facility
|
OP
|
$19.88
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
900911036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$250.65 |
| Rate for Payer: Adventist Health Commercial |
$3.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.65
|
| Rate for Payer: Blue Shield of California Commercial |
$13.86
|
| Rate for Payer: Blue Shield of California Commercial |
$9.16
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Cigna of CA HMO |
$12.72
|
| Rate for Payer: Cigna of CA PPO |
$14.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.90
|
| Rate for Payer: EPIC Health Plan Senior |
$26.60
|
| Rate for Payer: Galaxy Health WC |
$16.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$15.90
|
| Rate for Payer: Networks By Design Commercial |
$12.92
|
| Rate for Payer: Prime Health Services Commercial |
$16.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.58
|
| Rate for Payer: United Healthcare All Other HMO |
$19.58
|
| Rate for Payer: United Healthcare HMO Rider |
$19.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.60
|
| Rate for Payer: Vantage Medical Group Senior |
$24.18
|
|
|
HC SOM ESTRIOL
|
Facility
|
IP
|
$19.88
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
900911036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Adventist Health Commercial |
$3.98
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: EPIC Health Plan Senior |
$7.95
|
| Rate for Payer: Galaxy Health WC |
$16.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$15.90
|
| Rate for Payer: Networks By Design Commercial |
$12.92
|
| Rate for Payer: Prime Health Services Commercial |
$16.90
|
|
|
HC SOM ESTRONE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
900911482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.17
|
| Rate for Payer: EPIC Health Plan Senior |
$27.45
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.43
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.21
|
| Rate for Payer: United Healthcare All Other HMO |
$20.21
|
| Rate for Payer: United Healthcare HMO Rider |
$20.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Vantage Medical Group Senior |
$24.95
|
|
|
HC SOM ESTRONE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
900911482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ETHANOL, U
|
Facility
|
IP
|
$49.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$42.41 |
| Rate for Payer: Adventist Health Commercial |
$9.98
|
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.96
|
| Rate for Payer: EPIC Health Plan Senior |
$19.96
|
| Rate for Payer: Galaxy Health WC |
$42.41
|
| Rate for Payer: Global Benefits Group Commercial |
$29.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$39.92
|
| Rate for Payer: Networks By Design Commercial |
$32.44
|
| Rate for Payer: Prime Health Services Commercial |
$42.41
|
|
|
HC SOM ETHANOL, U
|
Facility
|
OP
|
$49.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$107.01 |
| Rate for Payer: Adventist Health Commercial |
$9.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.01
|
| Rate for Payer: Blue Shield of California Commercial |
$23.00
|
| Rate for Payer: Blue Shield of California Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Cigna of CA HMO |
$31.94
|
| Rate for Payer: Cigna of CA PPO |
$36.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.96
|
| Rate for Payer: EPIC Health Plan Senior |
$19.96
|
| Rate for Payer: Galaxy Health WC |
$42.41
|
| Rate for Payer: Global Benefits Group Commercial |
$29.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.93
|
| Rate for Payer: Multiplan Commercial |
$39.92
|
| Rate for Payer: Networks By Design Commercial |
$32.44
|
| Rate for Payer: Prime Health Services Commercial |
$42.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.95
|
| Rate for Payer: United Healthcare All Other HMO |
$24.95
|
| Rate for Payer: United Healthcare HMO Rider |
$24.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.41
|
| Rate for Payer: Vantage Medical Group Senior |
$42.41
|
|
|
HC SOM ETHCHLORVINYL (PLACIDYL)
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$636.03 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.34
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM ETHCHLORVINYL (PLACIDYL)
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM ETHOSUXIMIDE (ZARONTIN)
|
Facility
|
OP
|
$37.58
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
900910338
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$168.65 |
| Rate for Payer: Adventist Health Commercial |
$7.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.65
|
| Rate for Payer: Blue Shield of California Commercial |
$17.32
|
| Rate for Payer: Blue Shield of California Commercial |
$26.19
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Cigna of CA HMO |
$24.05
|
| Rate for Payer: Cigna of CA PPO |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.96
|
| Rate for Payer: EPIC Health Plan Senior |
$17.97
|
| Rate for Payer: Galaxy Health WC |
$31.94
|
| Rate for Payer: Global Benefits Group Commercial |
$22.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.90
|
| Rate for Payer: Multiplan Commercial |
$30.06
|
| Rate for Payer: Networks By Design Commercial |
$24.43
|
| Rate for Payer: Prime Health Services Commercial |
$31.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO |
$13.24
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.34
|
|
|
HC SOM ETHOSUXIMIDE (ZARONTIN)
|
Facility
|
IP
|
$37.58
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
900910338
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$31.94 |
| Rate for Payer: Adventist Health Commercial |
$7.52
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.03
|
| Rate for Payer: EPIC Health Plan Senior |
$15.03
|
| Rate for Payer: Galaxy Health WC |
$31.94
|
| Rate for Payer: Global Benefits Group Commercial |
$22.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$30.06
|
| Rate for Payer: Networks By Design Commercial |
$24.43
|
| Rate for Payer: Prime Health Services Commercial |
$31.94
|
|
|
HC SOM EVEROLIMUS B
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913810
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$110.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.68
|
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.19
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC SOM EVEROLIMUS B
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913810
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
