|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
IP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Central Health Plan Commercial |
$19.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.70
|
| Rate for Payer: EPIC Health Plan Senior |
$9.70
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
|
|
HC SOM METANEPHRINES,FRACT,FREE,P
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912922
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Adventist Health Commercial |
$4.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.02
|
| Rate for Payer: Blue Shield of California Commercial |
$14.73
|
| Rate for Payer: Blue Shield of California EPN |
$9.63
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Cash Price |
$24.26
|
| Rate for Payer: Central Health Plan Commercial |
$19.41
|
| Rate for Payer: Cigna of CA HMO |
$15.53
|
| Rate for Payer: Cigna of CA PPO |
$17.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$20.62
|
| Rate for Payer: Global Benefits Group Commercial |
$14.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: InnovAge PACE Commercial |
$25.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$18.20
|
| Rate for Payer: Networks By Design Commercial |
$15.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.94
|
| Rate for Payer: Prime Health Services Commercial |
$20.62
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
IP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$102.67 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Central Health Plan Commercial |
$91.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.63
|
| Rate for Payer: EPIC Health Plan Senior |
$45.63
|
| Rate for Payer: Galaxy Health WC |
$96.97
|
| Rate for Payer: Global Benefits Group Commercial |
$68.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
| Rate for Payer: Networks By Design Commercial |
$74.15
|
| Rate for Payer: Prime Health Services Commercial |
$96.97
|
|
|
HC SOM METHADONE CONFIRMATION, U
|
Facility
|
OP
|
$114.08
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
900912918
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.82 |
| Max. Negotiated Rate |
$113.97 |
| Rate for Payer: Adventist Health Commercial |
$22.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.13
|
| Rate for Payer: Blue Shield of California Commercial |
$69.25
|
| Rate for Payer: Blue Shield of California EPN |
$45.29
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Cash Price |
$114.08
|
| Rate for Payer: Central Health Plan Commercial |
$91.26
|
| Rate for Payer: Cigna of CA HMO |
$73.01
|
| Rate for Payer: Cigna of CA PPO |
$84.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.63
|
| Rate for Payer: EPIC Health Plan Senior |
$45.63
|
| Rate for Payer: Galaxy Health WC |
$96.97
|
| Rate for Payer: Global Benefits Group Commercial |
$68.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.67
|
| Rate for Payer: InnovAge PACE Commercial |
$57.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.86
|
| Rate for Payer: Multiplan Commercial |
$85.56
|
| Rate for Payer: Networks By Design Commercial |
$74.15
|
| Rate for Payer: Prime Health Services Commercial |
$96.97
|
| Rate for Payer: Riverside University Health System MISP |
$45.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.04
|
| Rate for Payer: United Healthcare All Other HMO |
$57.04
|
| Rate for Payer: United Healthcare HMO Rider |
$57.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.97
|
| Rate for Payer: Vantage Medical Group Senior |
$96.97
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
OP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$108.48 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.13
|
| 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 |
$9.82
|
| Rate for Payer: Blue Shield of California EPN |
$6.42
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Central Health Plan Commercial |
$12.94
|
| Rate for Payer: Cigna of CA HMO |
$10.36
|
| Rate for Payer: Cigna of CA PPO |
$11.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.47
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$13.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.56
|
| Rate for Payer: InnovAge PACE Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.33
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$10.52
|
| Rate for Payer: Prime Health Services Commercial |
$13.75
|
| Rate for Payer: Riverside University Health System MISP |
$6.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.09
|
| Rate for Payer: United Healthcare All Other HMO |
$8.09
|
| Rate for Payer: United Healthcare HMO Rider |
$8.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Vantage Medical Group Senior |
$13.75
|
|
|
HC SOM METHANPHETAMINE QUANT
|
Facility
|
IP
|
$16.18
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912822
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$14.56 |
| Rate for Payer: Adventist Health Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Central Health Plan Commercial |
$12.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.47
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$13.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$12.13
|
| Rate for Payer: Networks By Design Commercial |
$10.52
|
| Rate for Payer: Prime Health Services Commercial |
$13.75
|
|
|
HC SOM METHEMOGLOBIN
|
Facility
|
IP
|
$122.81
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900915429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$110.53 |
| Rate for Payer: Adventist Health Commercial |
$24.56
|
| Rate for Payer: Cash Price |
$122.81
|
| Rate for Payer: Central Health Plan Commercial |
$98.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.12
|
| Rate for Payer: EPIC Health Plan Senior |
$49.12
|
| Rate for Payer: Galaxy Health WC |
$104.39
|
| Rate for Payer: Global Benefits Group Commercial |
$73.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.56
|
| Rate for Payer: Multiplan Commercial |
$92.11
|
| Rate for Payer: Networks By Design Commercial |
$79.83
|
| Rate for Payer: Prime Health Services Commercial |
$104.39
|
|
|
HC SOM METHEMOGLOBIN
|
Facility
|
OP
|
$122.81
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900915429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$110.53 |
| Rate for Payer: Adventist Health Commercial |
$24.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.81
|
| Rate for Payer: Blue Shield of California Commercial |
$74.55
|
| Rate for Payer: Blue Shield of California EPN |
$48.76
|
| Rate for Payer: Cash Price |
$122.81
|
| Rate for Payer: Cash Price |
$122.81
|
| Rate for Payer: Central Health Plan Commercial |
$98.25
|
| Rate for Payer: Cigna of CA HMO |
$78.60
|
| Rate for Payer: Cigna of CA PPO |
$90.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.07
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$104.39
|
| Rate for Payer: Global Benefits Group Commercial |
$73.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.20
|
| Rate for Payer: InnovAge PACE Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.99
|
| Rate for Payer: Multiplan Commercial |
$92.11
|
| Rate for Payer: Networks By Design Commercial |
$79.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.20
|
| Rate for Payer: Prime Health Services Commercial |
$104.39
|
| Rate for Payer: Prime Health Services Medicare |
$8.69
|
| Rate for Payer: Riverside University Health System MISP |
$9.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.29
|
| 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 |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.63
|
| Rate for Payer: EPIC Health Plan Senior |
$21.21
|
| 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 |
$34.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: InnovAge PACE Commercial |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.42
|
| 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 |
$21.21
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$22.48
|
| Rate for Payer: Riverside University Health System MISP |
$23.33
|
| 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 |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM METHYLMALONIC ACID
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900911265
|
|
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 METHYLMALONIC ACID URINE
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.29
|
| 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 |
$31.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.63
|
| Rate for Payer: EPIC Health Plan Senior |
$21.21
|
| 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 |
$34.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.21
|
| Rate for Payer: InnovAge PACE Commercial |
$31.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.42
|
| 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 |
$21.21
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$22.48
|
| Rate for Payer: Riverside University Health System MISP |
$23.33
|
| 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 |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.33
|
| Rate for Payer: Vantage Medical Group Senior |
$21.21
|
|
|
HC SOM METHYLMALONIC ACID URINE
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
900910587
|
|
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 MEXILETINE PLASMA
|
Facility
|
OP
|
$289.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$260.82 |
| Rate for Payer: Adventist Health Commercial |
$57.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care 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 |
$21.50
|
| Rate for Payer: Blue Shield of California Commercial |
$175.91
|
| Rate for Payer: Blue Shield of California EPN |
$115.05
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$231.84
|
| Rate for Payer: Cigna of CA HMO |
$185.47
|
| Rate for Payer: Cigna of CA PPO |
$214.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$246.33
|
| Rate for Payer: Global Benefits Group Commercial |
$173.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.96
|
| 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 |
$217.35
|
| Rate for Payer: Networks By Design Commercial |
$188.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$246.33
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.88
|
| 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: Upland Medical Group Pediatric |
$18.64
|
| 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 MEXILETINE PLASMA
|
Facility
|
IP
|
$289.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$260.82 |
| Rate for Payer: Adventist Health Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$289.80
|
| Rate for Payer: Central Health Plan Commercial |
$231.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.92
|
| Rate for Payer: EPIC Health Plan Senior |
$115.92
|
| Rate for Payer: Galaxy Health WC |
$246.33
|
| Rate for Payer: Global Benefits Group Commercial |
$173.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$217.35
|
| Rate for Payer: Networks By Design Commercial |
$188.37
|
| Rate for Payer: Prime Health Services Commercial |
$246.33
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.95
|
| Rate for Payer: Blue Shield of California Commercial |
$163.28
|
| Rate for Payer: Blue Shield of California EPN |
$106.79
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLE ACH RECEPTOR BINDING AB
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900911445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$269.00
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC SOM MGLE P/Q TYPE CA CHANNEL AB
|
Facility
|
OP
|
$176.17
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900915420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$158.55 |
| Rate for Payer: Adventist Health Commercial |
$35.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.64
|
| Rate for Payer: Blue Shield of California Commercial |
$106.94
|
| Rate for Payer: Blue Shield of California EPN |
$69.94
|
| Rate for Payer: Cash Price |
$176.17
|
| Rate for Payer: Cash Price |
$176.17
|
| Rate for Payer: Central Health Plan Commercial |
$140.94
|
| Rate for Payer: Cigna of CA HMO |
$112.75
|
| Rate for Payer: Cigna of CA PPO |
$130.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$149.74
|
| Rate for Payer: Global Benefits Group Commercial |
$105.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$132.13
|
| Rate for Payer: Networks By Design Commercial |
$114.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$149.74
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM MGLE P/Q TYPE CA CHANNEL AB
|
Facility
|
IP
|
$176.17
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900915420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$158.55 |
| Rate for Payer: Adventist Health Commercial |
$35.23
|
| Rate for Payer: Cash Price |
$176.17
|
| Rate for Payer: Central Health Plan Commercial |
$140.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.47
|
| Rate for Payer: EPIC Health Plan Senior |
$70.47
|
| Rate for Payer: Galaxy Health WC |
$149.74
|
| Rate for Payer: Global Benefits Group Commercial |
$105.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.23
|
| Rate for Payer: Multiplan Commercial |
$132.13
|
| Rate for Payer: Networks By Design Commercial |
$114.51
|
| Rate for Payer: Prime Health Services Commercial |
$149.74
|
|
|
HC SOM MGLES 83519A
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83519A
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.95
|
| Rate for Payer: Blue Shield of California Commercial |
$76.72
|
| Rate for Payer: Blue Shield of California EPN |
$50.18
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519B
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.95
|
| Rate for Payer: Blue Shield of California Commercial |
$76.72
|
| Rate for Payer: Blue Shield of California EPN |
$50.18
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519B
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83519C
|
Facility
|
IP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.77 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Central Health Plan Commercial |
$101.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.45
|
| Rate for Payer: Global Benefits Group Commercial |
$75.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
| Rate for Payer: Networks By Design Commercial |
$82.17
|
| Rate for Payer: Prime Health Services Commercial |
$107.45
|
|
|
HC SOM MGLES 83519C
|
Facility
|
OP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$113.77 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.95
|
| Rate for Payer: Blue Shield of California Commercial |
$76.73
|
| Rate for Payer: Blue Shield of California EPN |
$50.18
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: Central Health Plan Commercial |
$101.13
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.45
|
| Rate for Payer: Global Benefits Group Commercial |
$75.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: InnovAge PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
| Rate for Payer: Networks By Design Commercial |
$82.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.40
|
| Rate for Payer: Prime Health Services Commercial |
$107.45
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519D
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
