|
HC SOM CYSTIC FIBROSIS DNA
|
Facility
IP
|
$168.38
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
900911481
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.68 |
| Max. Negotiated Rate |
$151.54 |
| Rate for Payer: Cash Price |
$75.77
|
| Rate for Payer: Central Health Plan Commercial |
$134.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.35
|
| Rate for Payer: Galaxy Health WC |
$143.12
|
| Rate for Payer: Global Benefits Group Commercial |
$101.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.68
|
| Rate for Payer: Multiplan Commercial |
$126.28
|
| Rate for Payer: Networks By Design Commercial |
$109.45
|
| Rate for Payer: Prime Health Services Commercial |
$143.12
|
|
|
HC SOM CYSTIC FIBROSIS GENE MUTATION
|
Facility
IP
|
$131.62
|
|
|
Service Code
|
CPT 81222
|
| Hospital Charge Code |
900915427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$118.46 |
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Central Health Plan Commercial |
$105.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.65
|
| Rate for Payer: Galaxy Health WC |
$111.88
|
| Rate for Payer: Global Benefits Group Commercial |
$78.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.32
|
| Rate for Payer: Multiplan Commercial |
$98.72
|
| Rate for Payer: Networks By Design Commercial |
$85.55
|
| Rate for Payer: Prime Health Services Commercial |
$111.88
|
|
|
HC SOM CYSTIC FIBROSIS GENE MUTATION
|
Facility
OP
|
$131.62
|
|
|
Service Code
|
CPT 81222
|
| Hospital Charge Code |
900915427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$2,071.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$435.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,071.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$652.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$478.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$435.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$521.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$635.93
|
| Rate for Payer: BCBS Transplant Transplant |
$78.97
|
| Rate for Payer: Blue Shield of California Commercial |
$81.34
|
| Rate for Payer: Blue Shield of California EPN |
$63.97
|
| Rate for Payer: Caremore Medicare Advantage |
$435.07
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Central Health Plan Commercial |
$105.30
|
| Rate for Payer: Cigna of CA HMO |
$84.24
|
| Rate for Payer: Cigna of CA PPO |
$97.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$652.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$435.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$435.07
|
| Rate for Payer: Galaxy Health WC |
$111.88
|
| Rate for Payer: Global Benefits Group Commercial |
$78.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$98.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$713.51
|
| Rate for Payer: IEHP medi-cal |
$717.87
|
| Rate for Payer: IEHP Medicare Advantage |
$435.07
|
| Rate for Payer: Innovage PACE Commercial |
$652.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$582.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$582.99
|
| Rate for Payer: Multiplan Commercial |
$98.72
|
| Rate for Payer: Networks By Design Commercial |
$85.55
|
| Rate for Payer: Prime Health Services Commercial |
$111.88
|
| Rate for Payer: Prime Health Services Medicare |
$461.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$78.97
|
| Rate for Payer: Riverside University Health MISP |
$478.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.40
|
| Rate for Payer: United Healthcare All Other HMO |
$352.40
|
| Rate for Payer: United Healthcare HMO Rider |
$352.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$652.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.58
|
| Rate for Payer: Vantage Medical Group Senior |
$435.07
|
|
|
HC SOM DCP 83951
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC SOM DCP 83951
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$569.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$64.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$466.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$569.56
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$55.62
|
| Rate for Payer: Blue Shield of California EPN |
$43.74
|
| Rate for Payer: Caremore Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$64.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.41
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$105.63
|
| Rate for Payer: IEHP medi-cal |
$106.28
|
| Rate for Payer: IEHP Medicare Advantage |
$64.41
|
| Rate for Payer: Innovage PACE Commercial |
$96.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.31
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Medicare |
$68.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: Riverside University Health MISP |
$70.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.17
|
| Rate for Payer: United Healthcare All Other HMO |
$52.17
|
| Rate for Payer: United Healthcare HMO Rider |
$52.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare 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 |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$53.46
|
| Rate for Payer: Blue Shield of California Commercial |
$55.06
|
| Rate for Payer: Blue Shield of California EPN |
$43.30
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| 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: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: 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 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 |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.46
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$40.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| 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: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
|
|
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: Cash Price |
$40.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| 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: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
|
|
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 |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare 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 |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$53.46
|
| Rate for Payer: Blue Shield of California Commercial |
$55.06
|
| Rate for Payer: Blue Shield of California EPN |
$43.30
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| 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: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$66.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: 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 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 |
$66.82
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.46
|
| Rate for Payer: Riverside University Health 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: 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 |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare 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 |
$207.60
|
| Rate for Payer: BCBS Transplant Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| 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: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: IEHP medi-cal |
$19.02
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Innovage PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| 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: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: Riverside University Health 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: 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: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$36.68
|
| 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: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$36.68
|
| 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 |
$207.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: AlphaCare 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 |
$207.60
|
| Rate for Payer: BCBS Transplant Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Caremore Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| 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: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: IEHP medi-cal |
$19.02
|
| Rate for Payer: IEHP Medicare Advantage |
$11.53
|
| Rate for Payer: Innovage PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| 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: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: Riverside University Health 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: 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
IP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$63.22 |
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$63.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| 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 DESYREL (TRAZODONE)
|
Facility
OP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$152.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.34
|
| Rate for Payer: BCBS Transplant Transplant |
$42.15
|
| Rate for Payer: Blue Shield of California Commercial |
$43.41
|
| Rate for Payer: Blue Shield of California EPN |
$34.14
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cash Price |
$31.61
|
| 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: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$63.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52.69
|
| Rate for Payer: IEHP medi-cal |
$24.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.86
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.15
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
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: Cash Price |
$8.36
|
| Rate for Payer: Central Health Plan Commercial |
$14.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$224.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: AlphaCare 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 |
$224.26
|
| Rate for Payer: BCBS Transplant Transplant |
$11.15
|
| Rate for Payer: Blue Shield of California Commercial |
$11.48
|
| Rate for Payer: Blue Shield of California EPN |
$9.03
|
| Rate for Payer: Caremore Medicare Advantage |
$25.27
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$8.36
|
| 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 |
$37.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$13.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.44
|
| Rate for Payer: IEHP medi-cal |
$41.70
|
| Rate for Payer: IEHP Medicare Advantage |
$25.27
|
| Rate for Payer: Innovage PACE Commercial |
$37.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.39
|
| 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: Prime Health Services Commercial |
$15.79
|
| Rate for Payer: Prime Health Services Medicare |
$26.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.15
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$37.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
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 |
$136.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: AlphaCare 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 |
$136.45
|
| Rate for Payer: BCBS Transplant Transplant |
$10.84
|
| Rate for Payer: Blue Shield of California Commercial |
$11.17
|
| Rate for Payer: Blue Shield of California EPN |
$8.78
|
| Rate for Payer: Caremore Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$8.13
|
| Rate for Payer: Cash Price |
$8.13
|
| 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 |
$35.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$13.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: IEHP medi-cal |
$38.89
|
| Rate for Payer: IEHP Medicare Advantage |
$23.57
|
| Rate for Payer: Innovage PACE Commercial |
$35.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.05
|
| 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: Prime Health Services Commercial |
$15.36
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.84
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
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: Cash Price |
$8.13
|
| Rate for Payer: Central Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$8.14
|
| Rate for Payer: Central Health Plan Commercial |
$14.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$136.45 |
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$35.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: AlphaCare 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 |
$136.45
|
| Rate for Payer: BCBS Transplant Transplant |
$10.85
|
| Rate for Payer: Blue Shield of California Commercial |
$11.17
|
| Rate for Payer: Blue Shield of California EPN |
$8.79
|
| Rate for Payer: Caremore Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$8.14
|
| Rate for Payer: Cash Price |
$8.14
|
| 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 |
$35.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$13.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: IEHP medi-cal |
$38.89
|
| Rate for Payer: IEHP Medicare Advantage |
$23.57
|
| Rate for Payer: Innovage PACE Commercial |
$35.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.06
|
| 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: Prime Health Services Commercial |
$15.37
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.85
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$35.36
|
| 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: Cash Price |
$120.01
|
| Rate for Payer: Central Health Plan Commercial |
$213.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$0.06 |
| Max. Negotiated Rate |
$240.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$226.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$146.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$146.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.41
|
| Rate for Payer: BCBS Transplant Transplant |
$160.01
|
| Rate for Payer: Blue Shield of California Commercial |
$164.81
|
| Rate for Payer: Blue Shield of California EPN |
$129.61
|
| Rate for Payer: Cash Price |
$120.01
|
| Rate for Payer: Cash Price |
$120.01
|
| 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: EPIC Health Plan Commercial |
$106.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$200.01
|
| Rate for Payer: IEHP medi-cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.88
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$160.01
|
| Rate for Payer: Riverside University Health 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 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: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$179.46 |
| Rate for Payer: Adventist Health Medi-Cal |
$29.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: AlphaCare 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 |
$179.46
|
| Rate for Payer: BCBS Transplant Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$25.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Caremore Medicare Advantage |
$29.28
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| 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: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$30.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: IEHP medi-cal |
$48.31
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Medicare |
$31.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: Riverside University Health 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 |
$23.72
|
| Rate for Payer: United Healthcare All Other HMO |
$23.72
|
| Rate for Payer: United Healthcare HMO Rider |
$23.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.72
|
| 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
|
|
