|
HC SOM PCDES PCA-TR
|
Facility
|
OP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.45
|
| Rate for Payer: Blue Shield of California Commercial |
$17.39
|
| Rate for Payer: Blue Shield of California Commercial |
$26.29
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna of CA HMO |
$24.14
|
| Rate for Payer: Cigna of CA PPO |
$27.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM PCDES PCA-TR
|
Facility
|
IP
|
$37.72
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$32.06 |
| Rate for Payer: Adventist Health Commercial |
$7.54
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$32.06
|
| Rate for Payer: Global Benefits Group Commercial |
$22.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.05
|
| Rate for Payer: Multiplan Commercial |
$30.18
|
| Rate for Payer: Networks By Design Commercial |
$24.52
|
| Rate for Payer: Prime Health Services Commercial |
$32.06
|
|
|
HC SOM PENICILLIN G IGE
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
|
|
HC SOM PENICILLIN G IGE
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912843
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PENICILLIN V IGE
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$2.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PENICILLIN V IGE
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
|
|
HC SOM PERNIC ANEM CASC B12
|
Facility
|
OP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$155.59 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$125.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.59
|
| Rate for Payer: Blue Shield of California Commercial |
$36.55
|
| Rate for Payer: Blue Shield of California Commercial |
$55.26
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cigna of CA HMO |
$50.74
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.88
|
| Rate for Payer: EPIC Health Plan Senior |
$16.59
|
| Rate for Payer: Galaxy Health WC |
$67.39
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$63.42
|
| Rate for Payer: Networks By Design Commercial |
$51.53
|
| Rate for Payer: Prime Health Services Commercial |
$67.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM PERNIC ANEM CASC B12
|
Facility
|
IP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$67.39 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.71
|
| Rate for Payer: EPIC Health Plan Senior |
$31.71
|
| Rate for Payer: Galaxy Health WC |
$67.39
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.03
|
| Rate for Payer: Multiplan Commercial |
$63.42
|
| Rate for Payer: Networks By Design Commercial |
$51.53
|
| Rate for Payer: Prime Health Services Commercial |
$67.39
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| 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 |
$133.21
|
| Rate for Payer: Blue Shield of California Commercial |
$42.52
|
| Rate for Payer: Blue Shield of California Commercial |
$28.12
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$38.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.99
|
| 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
|
OP
|
$17.29
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Adventist Health Commercial |
$3.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.45
|
| 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 |
$117.99
|
| Rate for Payer: Blue Shield of California Commercial |
$12.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cigna of CA HMO |
$11.07
|
| Rate for Payer: Cigna of CA PPO |
$12.79
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.25
|
| Rate for Payer: EPIC Health Plan Senior |
$16.83
|
| Rate for Payer: Galaxy Health WC |
$14.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$10.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| 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 |
$13.83
|
| Rate for Payer: Networks By Design Commercial |
$11.24
|
| Rate for Payer: Prime Health Services Commercial |
$14.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.37
|
| 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 PHENOBARBITAL LEVEL
|
Facility
|
IP
|
$17.29
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Adventist Health Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.92
|
| Rate for Payer: EPIC Health Plan Senior |
$6.92
|
| Rate for Payer: Galaxy Health WC |
$14.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$13.83
|
| Rate for Payer: Networks By Design Commercial |
$11.24
|
| Rate for Payer: Prime Health Services Commercial |
$14.70
|
|
|
HC SOM PHI 2PROPSA
|
Facility
|
OP
|
$34.36
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900915520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$214.79 |
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: Adventist Health Commercial |
$6.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.11
|
| 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 |
$214.79
|
| Rate for Payer: Blue Shield of California Commercial |
$15.84
|
| Rate for Payer: Blue Shield of California Commercial |
$23.95
|
| Rate for Payer: Cash Price |
$34.36
|
| Rate for Payer: Cash Price |
$34.36
|
| Rate for Payer: Cigna of CA HMO |
$21.99
|
| Rate for Payer: Cigna of CA PPO |
$25.43
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$29.21
|
| Rate for Payer: Global Benefits Group Commercial |
$20.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$21.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.25
|
| 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 |
$27.49
|
| Rate for Payer: Networks By Design Commercial |
$22.33
|
| Rate for Payer: Prime Health Services Commercial |
$29.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.62
|
| 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 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
|
$34.36
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900915520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$29.21 |
| Rate for Payer: Adventist Health Commercial |
$6.87
|
| Rate for Payer: Cash Price |
$34.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$29.21
|
| Rate for Payer: Global Benefits Group Commercial |
$20.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$27.49
|
| Rate for Payer: Networks By Design Commercial |
$22.33
|
| Rate for Payer: Prime Health Services Commercial |
$29.21
|
|
|
HC SOM PHI FREE PSA
|
Facility
|
IP
|
$30.36
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900915519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.81 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.29
|
| Rate for Payer: Multiplan Commercial |
$24.29
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
|
|
HC SOM PHI FREE PSA
|
Facility
|
OP
|
$30.36
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900915519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$189.01 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| 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 |
$189.01
|
| Rate for Payer: Blue Shield of California Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$21.16
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cigna of CA HMO |
$19.43
|
| Rate for Payer: Cigna of CA PPO |
$22.47
|
| 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 |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$25.81
|
| Rate for Payer: Global Benefits Group Commercial |
$18.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$19.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.29
|
| 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 |
$24.29
|
| Rate for Payer: Networks By Design Commercial |
$19.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.22
|
| 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 PHOSPHATIDYL ETHANOL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
900915352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC SOM PHOSPHATIDYL ETHANOL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
900915352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$107.01 |
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.01
|
| Rate for Payer: Blue Shield of California Commercial |
$48.79
|
| Rate for Payer: Blue Shield of California Commercial |
$27.66
|
| Rate for Payer: Blue Shield of California Commercial |
$41.82
|
| Rate for Payer: Blue Shield of California Commercial |
$32.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$38.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$30.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.87
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.22
|
| 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 |
$211.56 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.56
|
| 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 |
$149.05
|
| Rate for Payer: Blue Shield of California Commercial |
$11.11
|
| Rate for Payer: Blue Shield of California Commercial |
$16.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.99
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$20.48
|
| Rate for Payer: Global Benefits Group Commercial |
$14.46
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$15.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.63
|
| 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 |
$361.51 |
| Rate for Payer: Adventist Health Commercial |
$15.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.51
|
| 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 |
$197.84
|
| Rate for Payer: Blue Shield of California Commercial |
$55.38
|
| Rate for Payer: Blue Shield of California Commercial |
$36.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.88
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$50.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.88
|
| 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
|
OP
|
$70.54
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.62
|
| Rate for Payer: Blue Shield of California Commercial |
$32.52
|
| Rate for Payer: Blue Shield of California Commercial |
$49.17
|
| 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 |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| 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 |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.38
|
| 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 Foundation Hospitals Commercial/Self Funded |
$44.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.62
|
| 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 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 |
$68.28
|
| Rate for Payer: Blue Shield of California Commercial |
$49.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.16
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.48
|
| 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 Foundation Hospitals Commercial/Self Funded |
$67.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.78
|
| 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
|
|
