|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$80.19 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$80.19 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$93.74 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.03
|
| Rate for Payer: Blue Shield of California Commercial |
$54.08
|
| Rate for Payer: Blue Shield of California EPN |
$35.37
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: Cigna of CA HMO |
$57.02
|
| Rate for Payer: Cigna of CA PPO |
$65.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| 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 |
$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 |
$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 |
$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 |
$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 |
$36.69
|
| 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 |
$11.00
|
| 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 |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| 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 |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| 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 DESMOGLEIN 1
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| 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 |
$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 |
$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 |
$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 |
$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 |
$36.69
|
| 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 |
$11.00
|
| 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 |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| 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 |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| 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 DESYREL (TRAZODONE)
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$124.89 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| 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 |
$42.64
|
| Rate for Payer: Blue Shield of California EPN |
$27.89
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| Rate for Payer: Cigna of CA HMO |
$44.96
|
| Rate for Payer: Cigna of CA PPO |
$51.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.23
|
| Rate for Payer: InnovAge PACE Commercial |
$35.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
| Rate for Payer: Riverside University Health System MISP |
$28.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.12
|
| Rate for Payer: United Healthcare HMO Rider |
$35.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.05
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
|
|
HC SOM DHEA
|
Facility
|
OP
|
$18.58
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$183.86 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.31
|
| Rate for Payer: Blue Shield of California Commercial |
$11.28
|
| Rate for Payer: Blue Shield of California EPN |
$7.38
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Central Health Plan Commercial |
$14.86
|
| Rate for Payer: Cigna of CA HMO |
$11.89
|
| Rate for Payer: Cigna of CA PPO |
$13.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Senior |
$25.27
|
| Rate for Payer: Galaxy Health WC |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: InnovAge PACE Commercial |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.27
|
| Rate for Payer: Prime Health Services Commercial |
$15.79
|
| Rate for Payer: Prime Health Services Medicare |
$26.79
|
| Rate for Payer: Riverside University Health System MISP |
$27.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.47
|
| Rate for Payer: United Healthcare All Other HMO |
$20.47
|
| Rate for Payer: United Healthcare HMO Rider |
$20.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM DHEA
|
Facility
|
IP
|
$18.58
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Central Health Plan Commercial |
$14.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.43
|
| Rate for Payer: EPIC Health Plan Senior |
$7.43
|
| Rate for Payer: Galaxy Health WC |
$15.79
|
| Rate for Payer: Global Benefits Group Commercial |
$11.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$13.94
|
| Rate for Payer: Networks By Design Commercial |
$12.08
|
| Rate for Payer: Prime Health Services Commercial |
$15.79
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
IP
|
$18.07
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$16.26 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Central Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$7.23
|
| Rate for Payer: Galaxy Health WC |
$15.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.61
|
| Rate for Payer: Multiplan Commercial |
$13.55
|
| Rate for Payer: Networks By Design Commercial |
$11.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.36
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
OP
|
$18.07
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.70
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California EPN |
$7.17
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Cash Price |
$18.07
|
| Rate for Payer: Central Health Plan Commercial |
$14.46
|
| Rate for Payer: Cigna of CA HMO |
$11.56
|
| Rate for Payer: Cigna of CA PPO |
$13.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$15.36
|
| Rate for Payer: Global Benefits Group Commercial |
$10.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: InnovAge PACE Commercial |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$13.55
|
| Rate for Payer: Networks By Design Commercial |
$11.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.36
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Riverside University Health System MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
IP
|
$18.08
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Adventist Health Commercial |
$3.62
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Central Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.23
|
| Rate for Payer: EPIC Health Plan Senior |
$7.23
|
| Rate for Payer: Galaxy Health WC |
$15.37
|
| Rate for Payer: Global Benefits Group Commercial |
$10.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$11.75
|
| Rate for Payer: Prime Health Services Commercial |
$15.37
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
OP
|
$18.08
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Adventist Health Commercial |
$3.62
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.70
|
| Rate for Payer: Blue Shield of California Commercial |
$10.97
|
| Rate for Payer: Blue Shield of California EPN |
$7.18
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Central Health Plan Commercial |
$14.46
|
| Rate for Payer: Cigna of CA HMO |
$11.57
|
| Rate for Payer: Cigna of CA PPO |
$13.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Senior |
$23.57
|
| Rate for Payer: Galaxy Health WC |
$15.37
|
| Rate for Payer: Global Benefits Group Commercial |
$10.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: InnovAge PACE Commercial |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$13.56
|
| Rate for Payer: Networks By Design Commercial |
$11.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$15.37
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Riverside University Health System MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
IP
|
$266.68
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$240.01 |
| Rate for Payer: Adventist Health Commercial |
$53.34
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Central Health Plan Commercial |
$213.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.67
|
| Rate for Payer: EPIC Health Plan Senior |
$106.67
|
| Rate for Payer: Galaxy Health WC |
$226.68
|
| Rate for Payer: Global Benefits Group Commercial |
$160.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.34
|
| Rate for Payer: Multiplan Commercial |
$200.01
|
| Rate for Payer: Networks By Design Commercial |
$173.34
|
| Rate for Payer: Prime Health Services Commercial |
$226.68
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
OP
|
$266.68
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$240.01 |
| Rate for Payer: Adventist Health Commercial |
$53.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.19
|
| Rate for Payer: Blue Shield of California Commercial |
$161.87
|
| Rate for Payer: Blue Shield of California EPN |
$105.87
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Cash Price |
$266.68
|
| Rate for Payer: Central Health Plan Commercial |
$213.34
|
| Rate for Payer: Cigna of CA HMO |
$170.68
|
| Rate for Payer: Cigna of CA PPO |
$197.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.67
|
| Rate for Payer: EPIC Health Plan Senior |
$106.67
|
| Rate for Payer: Galaxy Health WC |
$226.68
|
| Rate for Payer: Global Benefits Group Commercial |
$160.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$240.01
|
| Rate for Payer: InnovAge PACE Commercial |
$133.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.68
|
| Rate for Payer: Multiplan Commercial |
$200.01
|
| Rate for Payer: Networks By Design Commercial |
$173.34
|
| Rate for Payer: Prime Health Services Commercial |
$226.68
|
| Rate for Payer: Riverside University Health System MISP |
$106.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.34
|
| Rate for Payer: United Healthcare All Other HMO |
$133.34
|
| Rate for Payer: United Healthcare HMO Rider |
$133.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.68
|
| Rate for Payer: Vantage Medical Group Senior |
$226.68
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$147.13 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| 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 |
$147.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.86
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California EPN |
$16.28
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| 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 |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| 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 |
$27.35
|
| 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 |
$8.20
|
| 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 |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.28
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| 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 |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| 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 DILANTIN FREE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$101.97 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.70
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.58
|
| Rate for Payer: EPIC Health Plan Senior |
$13.76
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.76
|
| Rate for Payer: InnovAge PACE Commercial |
$20.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.44
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.76
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.59
|
| Rate for Payer: Riverside University Health System MISP |
$15.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$13.76
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM DILANTIN LV FREE PHENY TOT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
900912809
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$96.44 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.57
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: InnovAge PACE Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.25
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Riverside University Health System MISP |
$14.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM DIPHTHERIA ANTITOXOID (ELISA)
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900911755
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$109.07 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.14
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: InnovAge PACE Commercial |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.99
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
