|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.66
|
| Rate for Payer: EPIC Health Plan Senior |
$5.66
|
| Rate for Payer: Galaxy Health WC |
$12.03
|
| Rate for Payer: Global Benefits Group Commercial |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$9.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.03
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$159.39 |
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$12.03
|
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.39
|
| Rate for Payer: Blue Shield of California Commercial |
$9.47
|
| Rate for Payer: Blue Shield of California EPN |
$6.25
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$10.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: Global Benefits Group Commercial |
$8.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$9.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
IP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$94.22 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.34
|
| Rate for Payer: EPIC Health Plan Senior |
$44.34
|
| Rate for Payer: Galaxy Health WC |
$94.22
|
| Rate for Payer: Global Benefits Group Commercial |
$66.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$88.68
|
| Rate for Payer: Networks By Design Commercial |
$72.05
|
| Rate for Payer: Prime Health Services Commercial |
$94.22
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
OP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$1,422.70 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,422.70
|
| Rate for Payer: Blue Shield of California Commercial |
$74.16
|
| Rate for Payer: Blue Shield of California EPN |
$49.00
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cigna of CA HMO |
$70.94
|
| Rate for Payer: Cigna of CA PPO |
$82.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.78
|
| Rate for Payer: EPIC Health Plan Senior |
$173.17
|
| Rate for Payer: Galaxy Health WC |
$94.22
|
| Rate for Payer: Global Benefits Group Commercial |
$66.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.05
|
| Rate for Payer: Multiplan Commercial |
$88.68
|
| Rate for Payer: Networks By Design Commercial |
$72.05
|
| Rate for Payer: Prime Health Services Commercial |
$94.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.26
|
| Rate for Payer: United Healthcare All Other HMO |
$140.26
|
| Rate for Payer: United Healthcare HMO Rider |
$140.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META LT 15
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$1,775.60 |
| Rate for Payer: EPIC Health Plan Senior |
$188.57
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,775.60
|
| Rate for Payer: Blue Shield of California Commercial |
$83.62
|
| Rate for Payer: Blue Shield of California EPN |
$55.25
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.57
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$309.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.74
|
| Rate for Payer: United Healthcare All Other HMO |
$152.74
|
| Rate for Payer: United Healthcare HMO Rider |
$152.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$188.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM META LT 15
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
IP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$19.41
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$167.37 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.37
|
| Rate for Payer: Blue Shield of California Commercial |
$16.23
|
| Rate for Payer: Blue Shield of California EPN |
$10.72
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Cigna of CA HMO |
$15.53
|
| Rate for Payer: Cigna of CA PPO |
$17.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$19.41
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
IP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$96.97 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.63
|
| Rate for Payer: EPIC Health Plan Senior |
$45.63
|
| Rate for Payer: Galaxy Health WC |
$96.97
|
| Rate for Payer: Global Benefits Group Commercial |
$68.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.38
|
| Rate for Payer: Multiplan Commercial |
$91.26
|
| Rate for Payer: Networks By Design Commercial |
$74.15
|
| Rate for Payer: Prime Health Services Commercial |
$96.97
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
OP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$154.74 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.74
|
| Rate for Payer: Blue Shield of California Commercial |
$76.32
|
| Rate for Payer: Blue Shield of California EPN |
$50.42
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Cigna of CA HMO |
$73.01
|
| Rate for Payer: Cigna of CA PPO |
$84.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.63
|
| Rate for Payer: EPIC Health Plan Senior |
$45.63
|
| Rate for Payer: Galaxy Health WC |
$96.97
|
| Rate for Payer: Global Benefits Group Commercial |
$68.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.86
|
| Rate for Payer: Multiplan Commercial |
$91.26
|
| Rate for Payer: Networks By Design Commercial |
$74.15
|
| Rate for Payer: Prime Health Services Commercial |
$96.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.04
|
| Rate for Payer: United Healthcare All Other HMO |
$57.04
|
| Rate for Payer: United Healthcare HMO Rider |
$57.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.97
|
| Rate for Payer: Vantage Medical Group Senior |
$96.97
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$13.75 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.47
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$13.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: Networks By Design Commercial |
$10.52
|
| Rate for Payer: Prime Health Services Commercial |
$13.75
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$147.29 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.29
|
| Rate for Payer: Blue Shield of California Commercial |
$10.82
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cigna of CA HMO |
$10.36
|
| Rate for Payer: Cigna of CA PPO |
$11.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.47
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$13.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.33
|
| Rate for Payer: Multiplan Commercial |
$12.94
|
| Rate for Payer: Networks By Design Commercial |
$10.52
|
| Rate for Payer: Prime Health Services Commercial |
$13.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.09
|
| Rate for Payer: United Healthcare All Other HMO |
$8.09
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Vantage Medical Group Senior |
$13.75
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$162.52 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.52
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.63
|
| Rate for Payer: EPIC Health Plan Senior |
$21.21
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$162.52 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.52
|
| Rate for Payer: Blue Shield of California Commercial |
$14.72
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.63
|
| Rate for Payer: EPIC Health Plan Senior |
$21.21
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.42
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
|
OP
|
$289.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$246.33 |
| Rate for Payer: Adventist Health Commercial |
$57.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$193.88
|
| Rate for Payer: Blue Shield of California EPN |
$128.09
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cigna of CA HMO |
$185.47
|
| Rate for Payer: Cigna of CA PPO |
$214.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$246.33
|
| Rate for Payer: Global Benefits Group Commercial |
$173.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$231.84
|
| Rate for Payer: Networks By Design Commercial |
$188.37
|
| Rate for Payer: Prime Health Services Commercial |
$246.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM MEXILETINE PLASMA
|
Facility
|
IP
|
$289.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$246.33 |
| Rate for Payer: Adventist Health Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.92
|
| Rate for Payer: EPIC Health Plan Senior |
$115.92
|
| Rate for Payer: Galaxy Health WC |
$246.33
|
| Rate for Payer: Global Benefits Group Commercial |
$173.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.55
|
| Rate for Payer: Multiplan Commercial |
$231.84
|
| Rate for Payer: Networks By Design Commercial |
$188.37
|
| Rate for Payer: Prime Health Services Commercial |
$246.33
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$179.96
|
| Rate for Payer: Blue Shield of California EPN |
$118.90
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC SOM MGLES 83519A
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$107.44 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$101.12
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83519A
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$84.56
|
| Rate for Payer: Blue Shield of California EPN |
$55.87
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$101.12
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519B
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$107.44 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$101.12
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83519B
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$84.56
|
| Rate for Payer: Blue Shield of California EPN |
$55.87
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$101.12
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519C
|
Facility
|
OP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$84.57
|
| Rate for Payer: Blue Shield of California EPN |
$55.87
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.45
|
| Rate for Payer: Global Benefits Group Commercial |
$75.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$101.13
|
| Rate for Payer: Networks By Design Commercial |
$82.17
|
| Rate for Payer: Prime Health Services Commercial |
$107.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
