|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$127.47 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.47
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$26.96
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC SOM PHENOBARBITAL LEVEL
|
Facility
|
IP
|
$23.99
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.39 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.19
|
| Rate for Payer: Networks By Design Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Commercial |
$20.39
|
|
|
HC SOM PHENOBARBITAL LEVEL
|
Facility
|
OP
|
$23.99
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$112.91 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.91
|
| Rate for Payer: Blue Shield of California Commercial |
$16.05
|
| Rate for Payer: Blue Shield of California EPN |
$10.60
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cigna of CA HMO |
$15.35
|
| Rate for Payer: Cigna of CA PPO |
$17.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Senior |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$20.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.39
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$19.19
|
| Rate for Payer: Networks By Design Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Commercial |
$20.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC SOM PHI 2PROPSA
|
Facility
|
OP
|
$29.20
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900915520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$205.54 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.54
|
| Rate for Payer: Blue Shield of California Commercial |
$19.53
|
| Rate for Payer: Blue Shield of California EPN |
$12.91
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: Cigna of CA HMO |
$18.69
|
| Rate for Payer: Cigna of CA PPO |
$21.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$24.82
|
| Rate for Payer: Global Benefits Group Commercial |
$17.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$23.36
|
| Rate for Payer: Networks By Design Commercial |
$18.98
|
| Rate for Payer: Prime Health Services Commercial |
$24.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM PHI 2PROPSA
|
Facility
|
IP
|
$29.20
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900915520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.82
|
| Rate for Payer: Global Benefits Group Commercial |
$17.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.01
|
| Rate for Payer: Multiplan Commercial |
$23.36
|
| Rate for Payer: Networks By Design Commercial |
$18.98
|
| Rate for Payer: Prime Health Services Commercial |
$24.82
|
|
|
HC SOM PHI FREE PSA
|
Facility
|
IP
|
$25.80
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900915519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$21.93 |
| Rate for Payer: Adventist Health Commercial |
$5.16
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.32
|
| Rate for Payer: EPIC Health Plan Senior |
$10.32
|
| Rate for Payer: Galaxy Health WC |
$21.93
|
| Rate for Payer: Global Benefits Group Commercial |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.19
|
| Rate for Payer: Multiplan Commercial |
$20.64
|
| Rate for Payer: Networks By Design Commercial |
$16.77
|
| Rate for Payer: Prime Health Services Commercial |
$21.93
|
|
|
HC SOM PHI FREE PSA
|
Facility
|
OP
|
$25.80
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900915519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$180.87 |
| Rate for Payer: Adventist Health Commercial |
$5.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.92
|
| 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 |
$180.87
|
| Rate for Payer: Blue Shield of California Commercial |
$17.26
|
| Rate for Payer: Blue Shield of California EPN |
$11.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna of CA HMO |
$16.51
|
| Rate for Payer: Cigna of CA PPO |
$19.09
|
| 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: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$21.93
|
| Rate for Payer: Global Benefits Group Commercial |
$15.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.19
|
| 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 |
$20.64
|
| Rate for Payer: Networks By Design Commercial |
$16.77
|
| Rate for Payer: Prime Health Services Commercial |
$21.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.48
|
| 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 PHOSPHOLIPID AB IGA
|
Facility
|
IP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$24.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.48
|
| Rate for Payer: Global Benefits Group Commercial |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$19.28
|
| Rate for Payer: Networks By Design Commercial |
$15.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.48
|
|
|
HC SOM PHOSPHOLIPID AB IGA
|
Facility
|
OP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$142.64 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.64
|
| Rate for Payer: Blue Shield of California Commercial |
$16.12
|
| Rate for Payer: Blue Shield of California EPN |
$10.65
|
| Rate for Payer: Cash Price |
$24.10
|
| Rate for Payer: Cash Price |
$24.10
|
| Rate for Payer: Cigna of CA HMO |
$15.42
|
| Rate for Payer: Cigna of CA PPO |
$17.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Senior |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$20.48
|
| Rate for Payer: Global Benefits Group Commercial |
$14.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$19.28
|
| Rate for Payer: Networks By Design Commercial |
$15.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
|
OP
|
$79.46
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Adventist Health Commercial |
$15.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.32
|
| Rate for Payer: Blue Shield of California Commercial |
$53.16
|
| Rate for Payer: Blue Shield of California EPN |
$35.12
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cigna of CA HMO |
$50.85
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.62
|
| Rate for Payer: Multiplan Commercial |
$63.57
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.54
|
| Rate for Payer: Vantage Medical Group Senior |
$67.54
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
|
IP
|
$79.46
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$67.54 |
| Rate for Payer: Adventist Health Commercial |
$15.89
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.07
|
| Rate for Payer: Multiplan Commercial |
$63.57
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$59.96 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.22
|
| Rate for Payer: EPIC Health Plan Senior |
$28.22
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.93
|
| Rate for Payer: Multiplan Commercial |
$56.43
|
| Rate for Payer: Networks By Design Commercial |
$45.85
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$47.19
|
| Rate for Payer: Blue Shield of California EPN |
$31.18
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: Cigna of CA HMO |
$45.15
|
| Rate for Payer: Cigna of CA PPO |
$52.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$56.43
|
| Rate for Payer: Networks By Design Commercial |
$45.85
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
|
IP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
|
OP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$90.44 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.34
|
| Rate for Payer: Blue Shield of California Commercial |
$71.18
|
| Rate for Payer: Blue Shield of California EPN |
$47.03
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$85.12
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC SOM PKHD1 GENE
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,296.25 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,000.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$838.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$936.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,020.23
|
| Rate for Payer: Blue Shield of California EPN |
$674.05
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna of CA HMO |
$976.00
|
| Rate for Payer: Cigna of CA PPO |
$1,128.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,296.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,296.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$943.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,067.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,067.50
|
| Rate for Payer: Multiplan Commercial |
$1,220.00
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.50
|
| Rate for Payer: United Healthcare All Other HMO |
$762.50
|
| Rate for Payer: United Healthcare HMO Rider |
$762.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,296.25
|
|
|
HC SOM PKHD1 GENE
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,296.25 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$943.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.00
|
| Rate for Payer: Multiplan Commercial |
$1,220.00
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$64.64 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.64
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$6.53
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6.53
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
OP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$527.39 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$167.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$527.39
|
| Rate for Payer: Blue Shield of California Commercial |
$171.22
|
| Rate for Payer: Blue Shield of California EPN |
$113.13
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: Cigna of CA HMO |
$163.80
|
| Rate for Payer: Cigna of CA PPO |
$189.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$228.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.87
|
| Rate for Payer: EPIC Health Plan Senior |
$207.31
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$157.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$207.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$207.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$277.80
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.92
|
| Rate for Payer: United Healthcare All Other HMO |
$167.92
|
| Rate for Payer: United Healthcare HMO Rider |
$167.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$167.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$228.04
|
| Rate for Payer: Vantage Medical Group Senior |
$207.31
|
|
|
HC SOM PML/RARA QUANT, PCR
|
Facility
|
IP
|
$255.94
|
|
|
Service Code
|
CPT 81315
|
| Hospital Charge Code |
900913891
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Adventist Health Commercial |
$51.19
|
| Rate for Payer: Cash Price |
$255.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.38
|
| Rate for Payer: EPIC Health Plan Senior |
$102.38
|
| Rate for Payer: Galaxy Health WC |
$217.55
|
| Rate for Payer: Global Benefits Group Commercial |
$153.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.43
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$166.36
|
| Rate for Payer: Prime Health Services Commercial |
$217.55
|
|
|
HC SOM PNEUMOCYSTIS PCR
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$74.93
|
| Rate for Payer: Blue Shield of California EPN |
$49.50
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM PNEUMOCYSTIS PCR
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
|
HC SOM PORPHOBILINOGEN QUANT.
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
900912570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
