|
HC SOM MEASLES AB CSF IGG
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$93.74 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.03
|
| Rate for Payer: Blue Shield of California Commercial |
$13.66
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$14.40
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| 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 |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$93.74 |
| Rate for Payer: Adventist Health Commercial |
$4.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.03
|
| Rate for Payer: Blue Shield of California Commercial |
$13.66
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$14.40
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| 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 |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.02
|
| Rate for Payer: Blue Shield of California Commercial |
$21.29
|
| Rate for Payer: Blue Shield of California EPN |
$13.93
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Central Health Plan Commercial |
$28.06
|
| Rate for Payer: Cigna of CA HMO |
$22.45
|
| Rate for Payer: Cigna of CA PPO |
$25.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.03
|
| Rate for Payer: EPIC Health Plan Senior |
$14.03
|
| Rate for Payer: Galaxy Health WC |
$29.82
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.57
|
| Rate for Payer: InnovAge PACE Commercial |
$17.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.56
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
| Rate for Payer: Networks By Design Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$29.82
|
| Rate for Payer: Riverside University Health System MISP |
$14.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.54
|
| Rate for Payer: United Healthcare All Other HMO |
$17.54
|
| Rate for Payer: United Healthcare HMO Rider |
$17.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$29.82
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Central Health Plan Commercial |
$28.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.03
|
| Rate for Payer: EPIC Health Plan Senior |
$14.03
|
| Rate for Payer: Galaxy Health WC |
$29.82
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
| Rate for Payer: Networks By Design Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$29.82
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
IP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.41 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Central Health Plan Commercial |
$76.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.61
|
| Rate for Payer: Global Benefits Group Commercial |
$57.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
| Rate for Payer: Networks By Design Commercial |
$62.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.61
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
OP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$105.79 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.47
|
| Rate for Payer: Blue Shield of California Commercial |
$58.28
|
| Rate for Payer: Blue Shield of California EPN |
$38.12
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Cash Price |
$96.01
|
| Rate for Payer: Central Health Plan Commercial |
$76.81
|
| Rate for Payer: Cigna of CA HMO |
$61.45
|
| Rate for Payer: Cigna of CA PPO |
$71.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.61
|
| Rate for Payer: Global Benefits Group Commercial |
$57.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.41
|
| Rate for Payer: InnovAge PACE Commercial |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.21
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
| Rate for Payer: Networks By Design Commercial |
$62.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.61
|
| Rate for Payer: Riverside University Health System MISP |
$38.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.01
|
| Rate for Payer: United Healthcare All Other HMO |
$48.01
|
| Rate for Payer: United Healthcare HMO Rider |
$48.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.61
|
| Rate for Payer: Vantage Medical Group Senior |
$81.61
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
OP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.02
|
| Rate for Payer: Blue Shield of California Commercial |
$14.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.30
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Central Health Plan Commercial |
$18.74
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$17.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: EPIC Health Plan Senior |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.08
|
| Rate for Payer: InnovAge PACE Commercial |
$11.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
| Rate for Payer: Riverside University Health System MISP |
$9.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.91
|
| Rate for Payer: Vantage Medical Group Senior |
$19.91
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
IP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Central Health Plan Commercial |
$18.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: EPIC Health Plan Senior |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
OP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$135.76 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.55
|
| Rate for Payer: Blue Shield of California Commercial |
$29.79
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Central Health Plan Commercial |
$39.26
|
| Rate for Payer: Cigna of CA HMO |
$31.40
|
| Rate for Payer: Cigna of CA PPO |
$36.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: EPIC Health Plan Senior |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.16
|
| Rate for Payer: InnovAge PACE Commercial |
$24.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.35
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
| Rate for Payer: Riverside University Health System MISP |
$19.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.54
|
| Rate for Payer: United Healthcare All Other HMO |
$24.54
|
| Rate for Payer: United Healthcare HMO Rider |
$24.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.71
|
| Rate for Payer: Vantage Medical Group Senior |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
IP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Central Health Plan Commercial |
$39.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: EPIC Health Plan Senior |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
|
IP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$36.84 |
| Rate for Payer: Adventist Health Commercial |
$8.19
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Central Health Plan Commercial |
$32.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.37
|
| Rate for Payer: EPIC Health Plan Senior |
$16.37
|
| Rate for Payer: Galaxy Health WC |
$34.79
|
| Rate for Payer: Global Benefits Group Commercial |
$24.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$26.60
|
| Rate for Payer: Prime Health Services Commercial |
$34.79
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
|
OP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$135.76 |
| Rate for Payer: Adventist Health Commercial |
$8.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.55
|
| Rate for Payer: Blue Shield of California Commercial |
$24.84
|
| Rate for Payer: Blue Shield of California EPN |
$16.25
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Central Health Plan Commercial |
$32.74
|
| Rate for Payer: Cigna of CA HMO |
$26.20
|
| Rate for Payer: Cigna of CA PPO |
$30.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.37
|
| Rate for Payer: EPIC Health Plan Senior |
$16.37
|
| Rate for Payer: Galaxy Health WC |
$34.79
|
| Rate for Payer: Global Benefits Group Commercial |
$24.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.84
|
| Rate for Payer: InnovAge PACE Commercial |
$20.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.65
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$26.60
|
| Rate for Payer: Prime Health Services Commercial |
$34.79
|
| Rate for Payer: Riverside University Health System MISP |
$16.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.79
|
| Rate for Payer: Vantage Medical Group Senior |
$34.79
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Adventist Health Commercial |
$36.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.05
|
| Rate for Payer: Blue Shield of California Commercial |
$109.26
|
| Rate for Payer: Blue Shield of California EPN |
$71.46
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$115.20
|
| Rate for Payer: Cigna of CA PPO |
$133.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Senior |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: InnovAge PACE Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Riverside University Health System MISP |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.55
|
| Rate for Payer: Blue Shield of California Commercial |
$46.19
|
| Rate for Payer: Blue Shield of California EPN |
$30.21
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: InnovAge PACE Commercial |
$38.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
| Rate for Payer: Riverside University Health System MISP |
$30.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC SOM MENMS 81405
|
Facility
|
OP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$111.27 |
| Max. Negotiated Rate |
$1,714.49 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$301.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$337.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,714.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.96
|
| Rate for Payer: Blue Shield of California Commercial |
$337.70
|
| Rate for Payer: Blue Shield of California EPN |
$220.87
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Central Health Plan Commercial |
$445.08
|
| Rate for Payer: Cigna of CA HMO |
$356.06
|
| Rate for Payer: Cigna of CA PPO |
$411.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.82
|
| Rate for Payer: EPIC Health Plan Senior |
$301.35
|
| Rate for Payer: Galaxy Health WC |
$472.90
|
| Rate for Payer: Global Benefits Group Commercial |
$333.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$500.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$518.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: InnovAge PACE Commercial |
$452.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
| Rate for Payer: Networks By Design Commercial |
$361.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$301.35
|
| Rate for Payer: Prime Health Services Commercial |
$472.90
|
| Rate for Payer: Prime Health Services Medicare |
$319.43
|
| Rate for Payer: Riverside University Health System MISP |
$331.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOM MENMS 81405
|
Facility
|
IP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$111.27 |
| Max. Negotiated Rate |
$500.71 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Central Health Plan Commercial |
$445.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.54
|
| Rate for Payer: EPIC Health Plan Senior |
$222.54
|
| Rate for Payer: Galaxy Health WC |
$472.90
|
| Rate for Payer: Global Benefits Group Commercial |
$333.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$500.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$371.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$344.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.27
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
| Rate for Payer: Networks By Design Commercial |
$361.63
|
| Rate for Payer: Prime Health Services Commercial |
$472.90
|
|
|
HC SOM MEPERIDINE
|
Facility
|
OP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$135.76 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.55
|
| Rate for Payer: Blue Shield of California Commercial |
$59.66
|
| Rate for Payer: Blue Shield of California EPN |
$39.02
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Central Health Plan Commercial |
$78.62
|
| Rate for Payer: Cigna of CA HMO |
$62.90
|
| Rate for Payer: Cigna of CA PPO |
$72.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Senior |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.54
|
| Rate for Payer: Global Benefits Group Commercial |
$58.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.45
|
| Rate for Payer: InnovAge PACE Commercial |
$49.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.80
|
| Rate for Payer: Multiplan Commercial |
$73.71
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.54
|
| Rate for Payer: Riverside University Health System MISP |
$39.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.14
|
| Rate for Payer: United Healthcare All Other HMO |
$49.14
|
| Rate for Payer: United Healthcare HMO Rider |
$49.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.54
|
| Rate for Payer: Vantage Medical Group Senior |
$83.54
|
|
|
HC SOM MEPERIDINE
|
Facility
|
IP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$88.45 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Central Health Plan Commercial |
$78.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Senior |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.54
|
| Rate for Payer: Global Benefits Group Commercial |
$58.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Multiplan Commercial |
$73.71
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.54
|
|
|
HC SOM MERCURY BLOOD
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$117.74 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.90
|
| Rate for Payer: Blue Shield of California Commercial |
$13.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.95
|
| Rate for Payer: EPIC Health Plan Senior |
$16.26
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.26
|
| Rate for Payer: InnovAge PACE Commercial |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.26
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$17.24
|
| Rate for Payer: Riverside University Health System MISP |
$17.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.17
|
| Rate for Payer: United Healthcare All Other HMO |
$13.17
|
| Rate for Payer: United Healthcare HMO Rider |
$13.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC SOM MERCURY BLOOD
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM META 1-10
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
