|
HC SOM FISH UROTHELIAL CANCER
|
Facility
OP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$12,338.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,268.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,108.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,572.28
|
| Rate for Payer: BCBS Transplant Transplant |
$264.00
|
| Rate for Payer: Blue Shield of California Commercial |
$271.92
|
| Rate for Payer: Blue Shield of California EPN |
$213.84
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Central Health Plan Commercial |
$352.00
|
| Rate for Payer: Cigna of CA HMO |
$281.60
|
| Rate for Payer: Cigna of CA PPO |
$325.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$330.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: IEHP medi-cal |
$352.13
|
| Rate for Payer: IEHP Medicare Advantage |
$213.41
|
| Rate for Payer: Innovage PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$264.00
|
| Rate for Payer: Riverside University Health MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,338.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC SOM FISH UROTHELIAL CANCER
|
Facility
IP
|
$440.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
900910694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Cash Price |
$198.00
|
| Rate for Payer: Central Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.00
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.00
|
| Rate for Payer: Multiplan Commercial |
$330.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
|
|
HC SOM FLECAINIDE ACETATE
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.55
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: IEHP medi-cal |
$30.76
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Innovage PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Riverside University Health MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM FLECAINIDE ACETATE
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 80181
|
| Hospital Charge Code |
900910551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM FLEXERIL
|
Facility
IP
|
$69.50
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$62.55 |
| Rate for Payer: Cash Price |
$31.28
|
| Rate for Payer: Central Health Plan Commercial |
$55.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.80
|
| Rate for Payer: Galaxy Health WC |
$59.08
|
| Rate for Payer: Global Benefits Group Commercial |
$41.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.90
|
| Rate for Payer: Multiplan Commercial |
$52.12
|
| Rate for Payer: Networks By Design Commercial |
$45.18
|
| Rate for Payer: Prime Health Services Commercial |
$59.08
|
|
|
HC SOM FLEXERIL
|
Facility
OP
|
$69.50
|
|
|
Service Code
|
CPT 80369
|
| Hospital Charge Code |
900911448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$150.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$59.08
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.01
|
| Rate for Payer: BCBS Transplant Transplant |
$41.70
|
| Rate for Payer: Blue Shield of California Commercial |
$42.95
|
| Rate for Payer: Blue Shield of California EPN |
$33.78
|
| Rate for Payer: Cash Price |
$31.28
|
| Rate for Payer: Cash Price |
$31.28
|
| Rate for Payer: Central Health Plan Commercial |
$55.60
|
| Rate for Payer: Cigna of CA HMO |
$44.48
|
| Rate for Payer: Cigna of CA PPO |
$51.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.80
|
| Rate for Payer: Galaxy Health WC |
$59.08
|
| Rate for Payer: Global Benefits Group Commercial |
$41.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.55
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52.12
|
| Rate for Payer: IEHP medi-cal |
$24.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.90
|
| Rate for Payer: Multiplan Commercial |
$52.12
|
| Rate for Payer: Networks By Design Commercial |
$45.18
|
| Rate for Payer: Prime Health Services Commercial |
$59.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$41.70
|
| Rate for Payer: Riverside University Health MISP |
$27.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.75
|
| Rate for Payer: United Healthcare All Other HMO |
$34.75
|
| Rate for Payer: United Healthcare HMO Rider |
$34.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.08
|
| Rate for Payer: Vantage Medical Group Senior |
$59.08
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
OP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: BCBS Transplant Transplant |
$97.50
|
| Rate for Payer: Blue Shield of California Commercial |
$100.42
|
| Rate for Payer: Blue Shield of California EPN |
$78.98
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$73.13
|
| Rate for Payer: Cash Price |
$73.13
|
| Rate for Payer: Cash Price |
$73.13
|
| Rate for Payer: Cash Price |
$73.13
|
| Rate for Payer: Central Health Plan Commercial |
$130.00
|
| Rate for Payer: Cigna of CA HMO |
$104.00
|
| Rate for Payer: Cigna of CA PPO |
$120.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$138.12
|
| Rate for Payer: Global Benefits Group Commercial |
$97.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: IEHP medi-cal |
$13.33
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Innovage PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$121.88
|
| Rate for Payer: Networks By Design Commercial |
$105.62
|
| Rate for Payer: Prime Health Services Commercial |
$138.12
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SOM FLT3 D835 INTERP
|
Facility
IP
|
$162.50
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900914513
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Cash Price |
$73.13
|
| Rate for Payer: Central Health Plan Commercial |
$130.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.00
|
| Rate for Payer: Galaxy Health WC |
$138.12
|
| Rate for Payer: Global Benefits Group Commercial |
$97.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.50
|
| Rate for Payer: Multiplan Commercial |
$121.88
|
| Rate for Payer: Networks By Design Commercial |
$105.62
|
| Rate for Payer: Prime Health Services Commercial |
$138.12
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$165.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$455.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$556.00
|
| Rate for Payer: BCBS Transplant Transplant |
$99.00
|
| Rate for Payer: Blue Shield of California Commercial |
$101.97
|
| Rate for Payer: Blue Shield of California EPN |
$80.19
|
| Rate for Payer: Caremore Medicare Advantage |
$165.51
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$165.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$165.51
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$123.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.44
|
| Rate for Payer: IEHP medi-cal |
$273.09
|
| Rate for Payer: IEHP Medicare Advantage |
$165.51
|
| Rate for Payer: Innovage PACE Commercial |
$248.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.78
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Prime Health Services Medicare |
$175.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: Riverside University Health MISP |
$182.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.06
|
| Rate for Payer: United Healthcare All Other HMO |
$134.06
|
| Rate for Payer: United Healthcare HMO Rider |
$134.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.06
|
| Rate for Payer: Vantage Medical Group Senior |
$165.51
|
|
|
HC SOM FLT 3 & D835 VARIANT DET
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
900912984
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
IP
|
$247.70
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Cash Price |
$111.47
|
| Rate for Payer: Central Health Plan Commercial |
$198.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.08
|
| Rate for Payer: Galaxy Health WC |
$210.54
|
| Rate for Payer: Global Benefits Group Commercial |
$148.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.54
|
| Rate for Payer: Multiplan Commercial |
$185.78
|
| Rate for Payer: Networks By Design Commercial |
$161.00
|
| Rate for Payer: Prime Health Services Commercial |
$210.54
|
|
|
HC SOM FLUORIDE BLOOD
|
Facility
OP
|
$247.70
|
|
|
Service Code
|
CPT 82735
|
| Hospital Charge Code |
900911276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.52
|
| Rate for Payer: BCBS Transplant Transplant |
$148.62
|
| Rate for Payer: Blue Shield of California Commercial |
$153.08
|
| Rate for Payer: Blue Shield of California EPN |
$120.38
|
| Rate for Payer: Caremore Medicare Advantage |
$18.54
|
| Rate for Payer: Cash Price |
$111.47
|
| Rate for Payer: Cash Price |
$111.47
|
| Rate for Payer: Central Health Plan Commercial |
$198.16
|
| Rate for Payer: Cigna of CA HMO |
$158.53
|
| Rate for Payer: Cigna of CA PPO |
$183.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.54
|
| Rate for Payer: Galaxy Health WC |
$210.54
|
| Rate for Payer: Global Benefits Group Commercial |
$148.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.93
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$185.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.41
|
| Rate for Payer: IEHP medi-cal |
$30.59
|
| Rate for Payer: IEHP Medicare Advantage |
$18.54
|
| Rate for Payer: Innovage PACE Commercial |
$27.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$185.78
|
| Rate for Payer: Networks By Design Commercial |
$161.00
|
| Rate for Payer: Prime Health Services Commercial |
$210.54
|
| Rate for Payer: Prime Health Services Medicare |
$19.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$148.62
|
| Rate for Payer: Riverside University Health MISP |
$20.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.02
|
| Rate for Payer: United Healthcare All Other HMO |
$15.02
|
| Rate for Payer: United Healthcare HMO Rider |
$15.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.39
|
| Rate for Payer: Vantage Medical Group Senior |
$18.54
|
|
|
HC SOM FLUOXETINE
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
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 FLUOXETINE
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911433
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$129.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.22
|
| 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 |
$18.64
|
| 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 |
$27.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| 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 |
$30.57
|
| Rate for Payer: IEHP medi-cal |
$30.76
|
| Rate for Payer: IEHP Medicare Advantage |
$18.64
|
| Rate for Payer: Innovage PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$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 |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: Riverside University Health MISP |
$20.50
|
| 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 |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM FLUPHENAZINE
|
Facility
OP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$132.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$72.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.56
|
| Rate for Payer: BCBS Transplant Transplant |
$51.38
|
| Rate for Payer: Blue Shield of California Commercial |
$52.92
|
| Rate for Payer: Blue Shield of California EPN |
$41.62
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: Central Health Plan Commercial |
$68.50
|
| Rate for Payer: Cigna of CA HMO |
$54.80
|
| Rate for Payer: Cigna of CA PPO |
$63.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.25
|
| Rate for Payer: Galaxy Health WC |
$72.79
|
| Rate for Payer: Global Benefits Group Commercial |
$51.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.07
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.22
|
| Rate for Payer: IEHP medi-cal |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$64.22
|
| Rate for Payer: Networks By Design Commercial |
$55.66
|
| Rate for Payer: Prime Health Services Commercial |
$72.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.38
|
| Rate for Payer: Riverside University Health MISP |
$34.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.82
|
| Rate for Payer: United Healthcare All Other HMO |
$42.82
|
| Rate for Payer: United Healthcare HMO Rider |
$42.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.79
|
| Rate for Payer: Vantage Medical Group Senior |
$72.79
|
|
|
HC SOM FLUPHENAZINE
|
Facility
IP
|
$85.63
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
900911432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$77.07 |
| Rate for Payer: Cash Price |
$38.53
|
| Rate for Payer: Central Health Plan Commercial |
$68.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.25
|
| Rate for Payer: Galaxy Health WC |
$72.79
|
| Rate for Payer: Global Benefits Group Commercial |
$51.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.13
|
| Rate for Payer: Multiplan Commercial |
$64.22
|
| Rate for Payer: Networks By Design Commercial |
$55.66
|
| Rate for Payer: Prime Health Services Commercial |
$72.79
|
|
|
HC SOM FLURAZEPAM (DALMANE) LEVEL
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM FLURAZEPAM (DALMANE) LEVEL
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.75
|
| 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 |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: IEHP medi-cal |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC SOM FMGA 84181
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM FMGA 84181
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$151.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.14
|
| Rate for Payer: BCBS Transplant Transplant |
$75.00
|
| Rate for Payer: Blue Shield of California Commercial |
$77.25
|
| Rate for Payer: Blue Shield of California EPN |
$60.75
|
| Rate for Payer: Caremore Medicare Advantage |
$17.03
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$93.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.93
|
| Rate for Payer: IEHP medi-cal |
$28.10
|
| Rate for Payer: IEHP Medicare Advantage |
$17.03
|
| Rate for Payer: Innovage PACE Commercial |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$18.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: Riverside University Health MISP |
$18.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13.80
|
| Rate for Payer: United Healthcare HMO Rider |
$13.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM FMGS 83520A
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: BCBS Transplant Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMGS 83520A
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM FMGS 83520B
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: BCBS Transplant Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMGS 83520B
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM FMIS 83520
|
Facility
IP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$159.96 |
| Rate for Payer: Cash Price |
$79.98
|
| Rate for Payer: Central Health Plan Commercial |
$142.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.09
|
| Rate for Payer: Galaxy Health WC |
$151.07
|
| Rate for Payer: Global Benefits Group Commercial |
$106.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$133.30
|
| Rate for Payer: Networks By Design Commercial |
$115.52
|
| Rate for Payer: Prime Health Services Commercial |
$151.07
|
|
