|
HC SOM AMIODARONE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| 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: Health Management Network EPO/PPO |
$27.00
|
| 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 |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM AMIODARONE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80151
|
| Hospital Charge Code |
900911286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM AMITRIPTYLINE LEVEL
|
Facility
|
IP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.97 |
| Max. Negotiated Rate |
$211.35 |
| Rate for Payer: Adventist Health Commercial |
$46.97
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Central Health Plan Commercial |
$187.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.93
|
| Rate for Payer: EPIC Health Plan Senior |
$93.93
|
| Rate for Payer: Galaxy Health WC |
$199.61
|
| Rate for Payer: Global Benefits Group Commercial |
$140.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.97
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: Networks By Design Commercial |
$152.64
|
| Rate for Payer: Prime Health Services Commercial |
$199.61
|
|
|
HC SOM AMITRIPTYLINE LEVEL
|
Facility
|
OP
|
$234.83
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900912504
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$211.35 |
| Rate for Payer: Adventist Health Commercial |
$46.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$176.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.35
|
| Rate for Payer: Blue Shield of California Commercial |
$142.54
|
| Rate for Payer: Blue Shield of California EPN |
$93.23
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Cash Price |
$234.83
|
| Rate for Payer: Central Health Plan Commercial |
$187.86
|
| Rate for Payer: Cigna of CA HMO |
$150.29
|
| Rate for Payer: Cigna of CA PPO |
$173.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.93
|
| Rate for Payer: EPIC Health Plan Senior |
$93.93
|
| Rate for Payer: Galaxy Health WC |
$199.61
|
| Rate for Payer: Global Benefits Group Commercial |
$140.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.35
|
| Rate for Payer: InnovAge PACE Commercial |
$117.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$145.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.38
|
| Rate for Payer: Multiplan Commercial |
$176.12
|
| Rate for Payer: Networks By Design Commercial |
$152.64
|
| Rate for Payer: Prime Health Services Commercial |
$199.61
|
| Rate for Payer: Riverside University Health System MISP |
$93.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.42
|
| Rate for Payer: United Healthcare All Other HMO |
$117.42
|
| Rate for Payer: United Healthcare HMO Rider |
$117.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.61
|
| Rate for Payer: Vantage Medical Group Senior |
$199.61
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
OP
|
$285.90
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$257.31 |
| Rate for Payer: Adventist Health Commercial |
$57.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$214.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.22
|
| Rate for Payer: Blue Shield of California Commercial |
$173.54
|
| Rate for Payer: Blue Shield of California EPN |
$113.50
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Central Health Plan Commercial |
$228.72
|
| Rate for Payer: Cigna of CA HMO |
$182.98
|
| Rate for Payer: Cigna of CA PPO |
$211.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.36
|
| Rate for Payer: EPIC Health Plan Senior |
$114.36
|
| Rate for Payer: Galaxy Health WC |
$243.01
|
| Rate for Payer: Global Benefits Group Commercial |
$171.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.31
|
| Rate for Payer: InnovAge PACE Commercial |
$142.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.13
|
| Rate for Payer: Multiplan Commercial |
$214.43
|
| Rate for Payer: Networks By Design Commercial |
$185.84
|
| Rate for Payer: Prime Health Services Commercial |
$243.01
|
| Rate for Payer: Riverside University Health System MISP |
$114.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.95
|
| Rate for Payer: United Healthcare All Other HMO |
$142.95
|
| Rate for Payer: United Healthcare HMO Rider |
$142.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.01
|
| Rate for Payer: Vantage Medical Group Senior |
$243.01
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
IP
|
$285.90
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.18 |
| Max. Negotiated Rate |
$257.31 |
| Rate for Payer: Adventist Health Commercial |
$57.18
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Central Health Plan Commercial |
$228.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.36
|
| Rate for Payer: EPIC Health Plan Senior |
$114.36
|
| Rate for Payer: Galaxy Health WC |
$243.01
|
| Rate for Payer: Global Benefits Group Commercial |
$171.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$257.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.18
|
| Rate for Payer: Multiplan Commercial |
$214.43
|
| Rate for Payer: Networks By Design Commercial |
$185.84
|
| Rate for Payer: Prime Health Services Commercial |
$243.01
|
|
|
HC SOM AMOXAPINE
|
Facility
|
OP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$124.89 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.35
|
| Rate for Payer: Blue Shield of California Commercial |
$39.73
|
| Rate for Payer: Blue Shield of California EPN |
$25.99
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Central Health Plan Commercial |
$52.37
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$48.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.91
|
| Rate for Payer: InnovAge PACE Commercial |
$32.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.82
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
| Rate for Payer: Riverside University Health System MISP |
$26.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.73
|
| Rate for Payer: United Healthcare All Other HMO |
$32.73
|
| Rate for Payer: United Healthcare HMO Rider |
$32.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.64
|
| Rate for Payer: Vantage Medical Group Senior |
$55.64
|
|
|
HC SOM AMOXAPINE
|
Facility
|
IP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$58.91 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Central Health Plan Commercial |
$52.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
IP
|
$20.78
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Senior |
$8.31
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$13.51
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
OP
|
$20.78
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$119.31 |
| Rate for Payer: Adventist Health Commercial |
$4.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.21
|
| Rate for Payer: Blue Shield of California Commercial |
$12.61
|
| Rate for Payer: Blue Shield of California EPN |
$8.25
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Central Health Plan Commercial |
$16.62
|
| Rate for Payer: Cigna of CA HMO |
$13.30
|
| Rate for Payer: Cigna of CA PPO |
$15.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.31
|
| Rate for Payer: EPIC Health Plan Senior |
$8.31
|
| Rate for Payer: Galaxy Health WC |
$17.66
|
| Rate for Payer: Global Benefits Group Commercial |
$12.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.70
|
| Rate for Payer: InnovAge PACE Commercial |
$10.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$15.59
|
| Rate for Payer: Networks By Design Commercial |
$13.51
|
| Rate for Payer: Prime Health Services Commercial |
$17.66
|
| Rate for Payer: Riverside University Health System MISP |
$8.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.39
|
| Rate for Payer: United Healthcare All Other HMO |
$10.39
|
| Rate for Payer: United Healthcare HMO Rider |
$10.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.66
|
| Rate for Payer: Vantage Medical Group Senior |
$17.66
|
|
|
HC SOM AMYLASE BF
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$47.21 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.75
|
| Rate for Payer: EPIC Health Plan Senior |
$6.48
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: InnovAge PACE Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC SOM AMYLASE BF
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.21
|
| Rate for Payer: Blue Shield of California Commercial |
$14.57
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Senior |
$29.28
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: InnovAge PACE Commercial |
$43.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.28
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$31.04
|
| Rate for Payer: Riverside University Health System MISP |
$32.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.71
|
| Rate for Payer: United Healthcare All Other HMO |
$23.71
|
| Rate for Payer: United Healthcare HMO Rider |
$23.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$106.18 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.55
|
| Rate for Payer: Blue Shield of California Commercial |
$7.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.71
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: InnovAge PACE Commercial |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.60
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$15.48
|
| Rate for Payer: Riverside University Health System MISP |
$16.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
OP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$106.18 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.55
|
| Rate for Payer: Blue Shield of California Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California EPN |
$27.19
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Central Health Plan Commercial |
$54.80
|
| Rate for Payer: Cigna of CA HMO |
$43.84
|
| Rate for Payer: Cigna of CA PPO |
$50.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.71
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$58.23
|
| Rate for Payer: Global Benefits Group Commercial |
$41.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: InnovAge PACE Commercial |
$21.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$51.38
|
| Rate for Payer: Networks By Design Commercial |
$44.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.60
|
| Rate for Payer: Prime Health Services Commercial |
$58.23
|
| Rate for Payer: Prime Health Services Medicare |
$15.48
|
| Rate for Payer: Riverside University Health System MISP |
$16.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
IP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Central Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$58.23
|
| Rate for Payer: Global Benefits Group Commercial |
$41.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$51.38
|
| Rate for Payer: Networks By Design Commercial |
$44.52
|
| Rate for Payer: Prime Health Services Commercial |
$58.23
|
|
|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$247.87 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$33.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.31
|
| Rate for Payer: Blue Shield of California Commercial |
$48.56
|
| Rate for Payer: Blue Shield of California EPN |
$31.76
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$51.20
|
| Rate for Payer: Cigna of CA PPO |
$59.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.82
|
| Rate for Payer: EPIC Health Plan Senior |
$33.94
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$55.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.94
|
| Rate for Payer: InnovAge PACE Commercial |
$50.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.48
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33.94
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Prime Health Services Medicare |
$35.98
|
| Rate for Payer: Riverside University Health System MISP |
$37.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.50
|
| Rate for Payer: United Healthcare All Other HMO |
$27.50
|
| Rate for Payer: United Healthcare HMO Rider |
$27.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Vantage Medical Group Senior |
$33.94
|
|
|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
|
|
HC SOM ANTI-GBM TITER AB
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
|
|
HC SOM ANTI-GBM TITER AB
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$15.78
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM ANTI-LIVERKIDNEY MICROSOMAL AB
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911453
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$106.52 |
| Rate for Payer: Adventist Health Commercial |
$4.35
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.62
|
| Rate for Payer: Blue Shield of California Commercial |
$13.21
|
| Rate for Payer: Blue Shield of California EPN |
$8.64
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Central Health Plan Commercial |
$17.41
|
| Rate for Payer: Cigna of CA HMO |
$13.93
|
| Rate for Payer: Cigna of CA PPO |
$16.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.64
|
| Rate for Payer: EPIC Health Plan Senior |
$14.55
|
| Rate for Payer: Galaxy Health WC |
$18.50
|
| Rate for Payer: Global Benefits Group Commercial |
$13.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.55
|
| Rate for Payer: InnovAge PACE Commercial |
$21.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$14.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.55
|
| Rate for Payer: Prime Health Services Commercial |
$18.50
|
| Rate for Payer: Prime Health Services Medicare |
$15.42
|
| Rate for Payer: Riverside University Health System MISP |
$16.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.79
|
| Rate for Payer: United Healthcare All Other HMO |
$11.79
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.55
|
|
|
HC SOM ANTI-LIVERKIDNEY MICROSOMAL AB
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911453
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: Adventist Health Commercial |
$4.35
|
| Rate for Payer: Cash Price |
$21.76
|
| Rate for Payer: Central Health Plan Commercial |
$17.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.70
|
| Rate for Payer: EPIC Health Plan Senior |
$8.70
|
| Rate for Payer: Galaxy Health WC |
$18.50
|
| Rate for Payer: Global Benefits Group Commercial |
$13.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.35
|
| Rate for Payer: Multiplan Commercial |
$16.32
|
| Rate for Payer: Networks By Design Commercial |
$14.14
|
| Rate for Payer: Prime Health Services Commercial |
$18.50
|
|
|
HC SOM ANTIMULLERIAN HORMONE, S
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
