|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
IP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Central Health Plan Commercial |
$11.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
|
|
HC SOM LAMICTAL (LAMOTRIGINE)
|
Facility
OP
|
$14.32
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
900910411
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$94.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.73
|
| Rate for Payer: BCBS Transplant Transplant |
$8.59
|
| Rate for Payer: Blue Shield of California Commercial |
$8.85
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Caremore Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Central Health Plan Commercial |
$11.46
|
| Rate for Payer: Cigna of CA HMO |
$9.16
|
| Rate for Payer: Cigna of CA PPO |
$10.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.89
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: IEHP medi-cal |
$21.86
|
| Rate for Payer: IEHP Medicare Advantage |
$13.25
|
| Rate for Payer: Innovage PACE Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.59
|
| Rate for Payer: Riverside University Health MISP |
$14.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LASIX
|
Facility
IP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Central Health Plan Commercial |
$95.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.71
|
| Rate for Payer: Galaxy Health WC |
$101.39
|
| Rate for Payer: Global Benefits Group Commercial |
$71.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.86
|
| Rate for Payer: Multiplan Commercial |
$89.46
|
| Rate for Payer: Networks By Design Commercial |
$77.53
|
| Rate for Payer: Prime Health Services Commercial |
$101.39
|
|
|
HC SOM LASIX
|
Facility
OP
|
$119.28
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| 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 |
$71.57
|
| Rate for Payer: Blue Shield of California Commercial |
$73.72
|
| Rate for Payer: Blue Shield of California EPN |
$57.97
|
| Rate for Payer: Caremore Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Cash Price |
$53.68
|
| Rate for Payer: Central Health Plan Commercial |
$95.42
|
| Rate for Payer: Cigna of CA HMO |
$76.34
|
| Rate for Payer: Cigna of CA PPO |
$88.27
|
| 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 |
$101.39
|
| Rate for Payer: Global Benefits Group Commercial |
$71.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$107.35
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$89.46
|
| 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 |
$79.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.86
|
| 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 |
$89.46
|
| Rate for Payer: Networks By Design Commercial |
$77.53
|
| Rate for Payer: Prime Health Services Commercial |
$101.39
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$71.57
|
| Rate for Payer: Riverside University Health MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.57
|
| 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 LD ACTIVITY TOTAL
|
Facility
OP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.41
|
| Rate for Payer: BCBS Transplant Transplant |
$6.74
|
| Rate for Payer: Blue Shield of California Commercial |
$6.94
|
| Rate for Payer: Blue Shield of California EPN |
$5.46
|
| Rate for Payer: Caremore Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.91
|
| Rate for Payer: IEHP medi-cal |
$9.97
|
| Rate for Payer: IEHP Medicare Advantage |
$6.04
|
| Rate for Payer: Innovage PACE Commercial |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Prime Health Services Medicare |
$6.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: Riverside University Health MISP |
$6.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC SOM LD ACTIVITY TOTAL
|
Facility
IP
|
$11.23
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912823
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC SOM LD ISOENZYMES
|
Facility
OP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$113.39 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.39
|
| Rate for Payer: BCBS Transplant Transplant |
$6.73
|
| Rate for Payer: Blue Shield of California Commercial |
$6.93
|
| Rate for Payer: Blue Shield of California EPN |
$5.45
|
| Rate for Payer: Caremore Medicare Advantage |
$12.79
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.18
|
| Rate for Payer: Cigna of CA PPO |
$8.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.79
|
| Rate for Payer: Galaxy Health WC |
$9.54
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.42
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.98
|
| Rate for Payer: IEHP medi-cal |
$21.10
|
| Rate for Payer: IEHP Medicare Advantage |
$12.79
|
| Rate for Payer: Innovage PACE Commercial |
$19.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.14
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.29
|
| Rate for Payer: Prime Health Services Commercial |
$9.54
|
| Rate for Payer: Prime Health Services Medicare |
$13.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.73
|
| Rate for Payer: Riverside University Health MISP |
$14.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.36
|
| Rate for Payer: United Healthcare All Other HMO |
$10.36
|
| Rate for Payer: United Healthcare HMO Rider |
$10.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Vantage Medical Group Senior |
$12.79
|
|
|
HC SOM LD ISOENZYMES
|
Facility
IP
|
$11.22
|
|
|
Service Code
|
CPT 83625
|
| Hospital Charge Code |
900910804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.54
|
| Rate for Payer: Global Benefits Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.29
|
| Rate for Payer: Prime Health Services Commercial |
$9.54
|
|
|
HC SOM LEAD BLOOD
|
Facility
OP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.41
|
| Rate for Payer: BCBS Transplant Transplant |
$5.46
|
| Rate for Payer: Blue Shield of California Commercial |
$5.62
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Caremore Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: IEHP medi-cal |
$19.98
|
| Rate for Payer: IEHP Medicare Advantage |
$12.11
|
| Rate for Payer: Innovage PACE Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: Riverside University Health MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM LEAD BLOOD
|
Facility
IP
|
$9.10
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Cash Price |
$4.10
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC SOM LEAD URINE
|
Facility
OP
|
$150.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$135.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.41
|
| Rate for Payer: BCBS Transplant Transplant |
$90.48
|
| Rate for Payer: Blue Shield of California Commercial |
$93.19
|
| Rate for Payer: Blue Shield of California EPN |
$73.29
|
| Rate for Payer: Caremore Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$67.86
|
| Rate for Payer: Cash Price |
$67.86
|
| Rate for Payer: Central Health Plan Commercial |
$120.64
|
| Rate for Payer: Cigna of CA HMO |
$96.51
|
| Rate for Payer: Cigna of CA PPO |
$111.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$128.18
|
| Rate for Payer: Global Benefits Group Commercial |
$90.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$113.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: IEHP medi-cal |
$19.98
|
| Rate for Payer: IEHP Medicare Advantage |
$12.11
|
| Rate for Payer: Innovage PACE Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: Networks By Design Commercial |
$98.02
|
| Rate for Payer: Prime Health Services Commercial |
$128.18
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.48
|
| Rate for Payer: Riverside University Health MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM LEAD URINE
|
Facility
IP
|
$150.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
900911141
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.16 |
| Max. Negotiated Rate |
$135.72 |
| Rate for Payer: Cash Price |
$67.86
|
| Rate for Payer: Central Health Plan Commercial |
$120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.32
|
| Rate for Payer: Galaxy Health WC |
$128.18
|
| Rate for Payer: Global Benefits Group Commercial |
$90.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.16
|
| Rate for Payer: Multiplan Commercial |
$113.10
|
| Rate for Payer: Networks By Design Commercial |
$98.02
|
| Rate for Payer: Prime Health Services Commercial |
$128.18
|
|
|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$201.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.27
|
| Rate for Payer: BCBS Transplant Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92.70
|
| Rate for Payer: Blue Shield of California EPN |
$72.90
|
| Rate for Payer: Caremore Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: IEHP medi-cal |
$63.64
|
| Rate for Payer: IEHP Medicare Advantage |
$38.57
|
| Rate for Payer: Innovage PACE Commercial |
$57.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$40.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: Riverside University Health MISP |
$42.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC SOM LEFLUNOMIDE METABOLITE
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 80193
|
| Hospital Charge Code |
900913937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM LEGIONELLA AB
|
Facility
IP
|
$14.90
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$13.41 |
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Central Health Plan Commercial |
$11.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.96
|
| Rate for Payer: Galaxy Health WC |
$12.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$12.66
|
|
|
HC SOM LEGIONELLA AB
|
Facility
OP
|
$14.90
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
900912567
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$133.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.82
|
| Rate for Payer: BCBS Transplant Transplant |
$8.94
|
| Rate for Payer: Blue Shield of California Commercial |
$9.21
|
| Rate for Payer: Blue Shield of California EPN |
$7.24
|
| Rate for Payer: Caremore Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Central Health Plan Commercial |
$11.92
|
| Rate for Payer: Cigna of CA HMO |
$9.54
|
| Rate for Payer: Cigna of CA PPO |
$11.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$12.66
|
| Rate for Payer: Global Benefits Group Commercial |
$8.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: IEHP medi-cal |
$25.24
|
| Rate for Payer: IEHP Medicare Advantage |
$15.30
|
| Rate for Payer: Innovage PACE Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$11.18
|
| Rate for Payer: Networks By Design Commercial |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$12.66
|
| Rate for Payer: Prime Health Services Medicare |
$16.22
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.94
|
| Rate for Payer: Riverside University Health MISP |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
OP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: BCBS Transplant Transplant |
$9.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.81
|
| Rate for Payer: Caremore Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$11.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.07
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: IEHP medi-cal |
$26.52
|
| Rate for Payer: IEHP Medicare Advantage |
$16.07
|
| Rate for Payer: Innovage PACE Commercial |
$24.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: Riverside University Health MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC SOM LEGIONELLA AG URINE
|
Facility
IP
|
$16.07
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900911293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
|
|
HC SOM LEPTOSPIRA IGM
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| 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 LEPTOSPIRA IGM
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
900911765
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$96.82 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.23
|
| 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 |
$16.20
|
| 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 |
$24.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.20
|
| 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 |
$26.57
|
| Rate for Payer: IEHP medi-cal |
$26.73
|
| Rate for Payer: IEHP Medicare Advantage |
$16.20
|
| Rate for Payer: Innovage PACE Commercial |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.71
|
| 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 |
$17.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Riverside University Health MISP |
$17.82
|
| 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 |
$13.12
|
| Rate for Payer: United Healthcare All Other HMO |
$13.12
|
| Rate for Payer: United Healthcare HMO Rider |
$13.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.82
|
| Rate for Payer: Vantage Medical Group Senior |
$16.20
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
OP
|
$14.50
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$94.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.73
|
| Rate for Payer: BCBS Transplant Transplant |
$8.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8.96
|
| Rate for Payer: Blue Shield of California EPN |
$7.05
|
| Rate for Payer: Caremore Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.60
|
| Rate for Payer: Cigna of CA HMO |
$9.28
|
| Rate for Payer: Cigna of CA PPO |
$10.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$12.32
|
| Rate for Payer: Global Benefits Group Commercial |
$8.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: IEHP medi-cal |
$21.86
|
| Rate for Payer: IEHP Medicare Advantage |
$13.25
|
| Rate for Payer: Innovage PACE Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.42
|
| Rate for Payer: Prime Health Services Commercial |
$12.32
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.70
|
| Rate for Payer: Riverside University Health MISP |
$14.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM LEVETIRACETAM LEVEL
|
Facility
IP
|
$14.50
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
900912530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Central Health Plan Commercial |
$11.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.80
|
| Rate for Payer: Galaxy Health WC |
$12.32
|
| Rate for Payer: Global Benefits Group Commercial |
$8.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.90
|
| Rate for Payer: Multiplan Commercial |
$10.88
|
| Rate for Payer: Networks By Design Commercial |
$9.42
|
| Rate for Payer: Prime Health Services Commercial |
$12.32
|
|
|
HC SOM LIPASE BF
|
Facility
IP
|
$25.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
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 LIPASE BF
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900913938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.05
|
| Rate for Payer: BCBS Transplant Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$8.26
|
| Rate for Payer: Caremore Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.30
|
| Rate for Payer: IEHP medi-cal |
$11.37
|
| Rate for Payer: IEHP Medicare Advantage |
$6.89
|
| Rate for Payer: Innovage PACE Commercial |
$10.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$7.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: Riverside University Health MISP |
$7.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC SOM LIPASE RANDOM URINE
|
Facility
IP
|
$67.10
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$60.39 |
| Rate for Payer: Cash Price |
$30.20
|
| Rate for Payer: Central Health Plan Commercial |
$53.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.84
|
| Rate for Payer: Galaxy Health WC |
$57.04
|
| Rate for Payer: Global Benefits Group Commercial |
$40.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$50.32
|
| Rate for Payer: Networks By Design Commercial |
$43.62
|
| Rate for Payer: Prime Health Services Commercial |
$57.04
|
|
