|
HC SOM FLUPHENAZINE
|
Facility
|
OP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$154.20 |
| Rate for Payer: Adventist Health Commercial |
$17.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.20
|
| Rate for Payer: Blue Shield of California Commercial |
$39.48
|
| Rate for Payer: Blue Shield of California Commercial |
$59.68
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cigna of CA HMO |
$54.80
|
| Rate for Payer: Cigna of CA PPO |
$63.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.25
|
| Rate for Payer: EPIC Health Plan Senior |
$34.25
|
| Rate for Payer: Galaxy Health WC |
$72.79
|
| Rate for Payer: Global Benefits Group Commercial |
$51.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.94
|
| Rate for Payer: Multiplan Commercial |
$68.50
|
| Rate for Payer: Networks By Design Commercial |
$55.66
|
| Rate for Payer: Prime Health Services Commercial |
$72.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.81
|
| Rate for Payer: United Healthcare All Other HMO |
$42.81
|
| Rate for Payer: United Healthcare HMO Rider |
$42.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.79
|
| Rate for Payer: Vantage Medical Group Senior |
$72.79
|
|
|
HC SOM FLUPHENAZINE
|
Facility
|
IP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$72.79 |
| Rate for Payer: Adventist Health Commercial |
$17.13
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.25
|
| Rate for Payer: EPIC Health Plan Senior |
$34.25
|
| Rate for Payer: Galaxy Health WC |
$72.79
|
| Rate for Payer: Global Benefits Group Commercial |
$51.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.55
|
| Rate for Payer: Multiplan Commercial |
$68.50
|
| Rate for Payer: Networks By Design Commercial |
$55.66
|
| Rate for Payer: Prime Health Services Commercial |
$72.79
|
|
|
HC SOM FLURAZEPAM (DALMANE) LEVEL
|
Facility
|
OP
|
$67.52
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$183.10 |
| Rate for Payer: Adventist Health Commercial |
$13.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.10
|
| Rate for Payer: Blue Shield of California Commercial |
$31.13
|
| Rate for Payer: Blue Shield of California Commercial |
$47.06
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Cigna of CA HMO |
$43.21
|
| Rate for Payer: Cigna of CA PPO |
$49.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.01
|
| Rate for Payer: EPIC Health Plan Senior |
$27.01
|
| Rate for Payer: Galaxy Health WC |
$57.39
|
| Rate for Payer: Global Benefits Group Commercial |
$40.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.26
|
| Rate for Payer: Multiplan Commercial |
$54.02
|
| Rate for Payer: Networks By Design Commercial |
$43.89
|
| Rate for Payer: Prime Health Services Commercial |
$57.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.76
|
| Rate for Payer: United Healthcare All Other HMO |
$33.76
|
| Rate for Payer: United Healthcare HMO Rider |
$33.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.39
|
| Rate for Payer: Vantage Medical Group Senior |
$57.39
|
|
|
HC SOM FLURAZEPAM (DALMANE) LEVEL
|
Facility
|
IP
|
$67.52
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$57.39 |
| Rate for Payer: Adventist Health Commercial |
$13.50
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.01
|
| Rate for Payer: EPIC Health Plan Senior |
$27.01
|
| Rate for Payer: Galaxy Health WC |
$57.39
|
| Rate for Payer: Global Benefits Group Commercial |
$40.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$54.02
|
| Rate for Payer: Networks By Design Commercial |
$43.89
|
| Rate for Payer: Prime Health Services Commercial |
$57.39
|
|
|
HC SOM FMGA 84181
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$175.81 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.81
|
| Rate for Payer: Blue Shield of California Commercial |
$57.62
|
| Rate for Payer: Blue Shield of California Commercial |
$87.12
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13.80
|
| Rate for Payer: United Healthcare HMO Rider |
$13.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM FMGA 84181
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.75
|
| 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 FMGS 83520A
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM FMGS 83520A
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$76.67
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMGS 83520B
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM FMGS 83520B
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$76.67
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMIS 83520
|
Facility
|
OP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$151.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Adventist Health Commercial |
$35.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.63
|
| Rate for Payer: Blue Shield of California Commercial |
$123.88
|
| Rate for Payer: Blue Shield of California Commercial |
$81.93
|
| Rate for Payer: Cash Price |
$177.73
|
| Rate for Payer: Cash Price |
$177.73
|
| Rate for Payer: Cigna of CA HMO |
$113.75
|
| Rate for Payer: Cigna of CA PPO |
$131.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$151.07
|
| Rate for Payer: Global Benefits Group Commercial |
$106.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$142.18
|
| Rate for Payer: Networks By Design Commercial |
$115.52
|
| Rate for Payer: Prime Health Services Commercial |
$151.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMIS 83520
|
Facility
|
IP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$151.07 |
| Rate for Payer: Adventist Health Commercial |
$35.55
|
| Rate for Payer: Cash Price |
$177.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.09
|
| Rate for Payer: EPIC Health Plan Senior |
$71.09
|
| Rate for Payer: Galaxy Health WC |
$151.07
|
| Rate for Payer: Global Benefits Group Commercial |
$106.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.66
|
| Rate for Payer: Multiplan Commercial |
$142.18
|
| Rate for Payer: Networks By Design Commercial |
$115.52
|
| Rate for Payer: Prime Health Services Commercial |
$151.07
|
|
|
HC SOM FNTSM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.97
|
| Rate for Payer: Blue Shield of California Commercial |
$80.67
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FNTSM 82492A
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FNTSM 82492A
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.97
|
| Rate for Payer: Blue Shield of California Commercial |
$80.67
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492B
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.97
|
| Rate for Payer: Blue Shield of California Commercial |
$80.67
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492B
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FOLATE, RBC
|
Facility
|
IP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.00
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
|
|
HC SOM FOLATE, RBC
|
Facility
|
OP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$185.33 |
| Rate for Payer: Cigna of CA PPO |
$38.85
|
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$144.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.33
|
| Rate for Payer: Blue Shield of California Commercial |
$24.20
|
| Rate for Payer: Blue Shield of California Commercial |
$36.59
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.41
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14.30
|
| Rate for Payer: United Healthcare HMO Rider |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC SOM FPRSG 84150
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.83 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Upland Medical Group Pediatric |
$41.77
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.60
|
| Rate for Payer: Blue Shield of California Commercial |
$161.35
|
| Rate for Payer: Blue Shield of California Commercial |
$243.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.92
|
| Rate for Payer: EPIC Health Plan Senior |
$45.95
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.97
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.83
|
| Rate for Payer: United Healthcare All Other HMO |
$33.83
|
| Rate for Payer: United Healthcare HMO Rider |
$33.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.77
|
|
|
HC SOM FPRSG 84150
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FPSAP 84153
|
Facility
|
OP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$189.84 |
| Rate for Payer: Adventist Health Commercial |
$17.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.84
|
| Rate for Payer: Blue Shield of California Commercial |
$41.26
|
| Rate for Payer: Blue Shield of California Commercial |
$62.38
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna of CA HMO |
$57.28
|
| Rate for Payer: Cigna of CA PPO |
$66.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$76.08
|
| Rate for Payer: Global Benefits Group Commercial |
$53.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$71.60
|
| Rate for Payer: Networks By Design Commercial |
$58.17
|
| Rate for Payer: Prime Health Services Commercial |
$76.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM FPSAP 84153
|
Facility
|
IP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Adventist Health Commercial |
$17.90
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.80
|
| Rate for Payer: EPIC Health Plan Senior |
$35.80
|
| Rate for Payer: Galaxy Health WC |
$76.08
|
| Rate for Payer: Global Benefits Group Commercial |
$53.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.48
|
| Rate for Payer: Multiplan Commercial |
$71.60
|
| Rate for Payer: Networks By Design Commercial |
$58.17
|
| Rate for Payer: Prime Health Services Commercial |
$76.08
|
|
|
HC SOM FQUET 82491
|
Facility
|
OP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$30.50
|
| Rate for Payer: Blue Shield of California Commercial |
$46.11
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Cigna of CA HMO |
$42.34
|
| Rate for Payer: Cigna of CA PPO |
$48.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$52.93
|
| Rate for Payer: Networks By Design Commercial |
$43.00
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
