|
HC SOM MBCR 88291 SOM
|
Facility
IP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Central Health Plan Commercial |
$20.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$19.64
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
OP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$165.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$15.71
|
| Rate for Payer: Blue Shield of California Commercial |
$16.19
|
| Rate for Payer: Blue Shield of California EPN |
$12.73
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Cash Price |
$11.79
|
| Rate for Payer: Central Health Plan Commercial |
$20.95
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$19.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.64
|
| Rate for Payer: IEHP medi-cal |
$9.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$19.64
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.71
|
| Rate for Payer: Riverside University Health MISP |
$10.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.26
|
| Rate for Payer: Vantage Medical Group Senior |
$22.26
|
|
|
HC SOM MCLON IFE U
|
Facility
OP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$215.42 |
| Rate for Payer: Adventist Health Medi-Cal |
$29.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.48
|
| Rate for Payer: BCBS Transplant Transplant |
$17.32
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Blue Shield of California EPN |
$14.03
|
| Rate for Payer: Caremore Medicare Advantage |
$29.35
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Central Health Plan Commercial |
$23.09
|
| Rate for Payer: Cigna of CA HMO |
$18.47
|
| Rate for Payer: Cigna of CA PPO |
$21.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.35
|
| Rate for Payer: Galaxy Health WC |
$24.53
|
| Rate for Payer: Global Benefits Group Commercial |
$17.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.97
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.13
|
| Rate for Payer: IEHP medi-cal |
$48.43
|
| Rate for Payer: IEHP Medicare Advantage |
$29.35
|
| Rate for Payer: Innovage PACE Commercial |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
| Rate for Payer: Networks By Design Commercial |
$18.76
|
| Rate for Payer: Prime Health Services Commercial |
$24.53
|
| Rate for Payer: Prime Health Services Medicare |
$31.11
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$17.32
|
| Rate for Payer: Riverside University Health MISP |
$32.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.78
|
| Rate for Payer: United Healthcare All Other HMO |
$23.78
|
| Rate for Payer: United Healthcare HMO Rider |
$23.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM MCLON IFE U
|
Facility
IP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Central Health Plan Commercial |
$23.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$24.53
|
| Rate for Payer: Global Benefits Group Commercial |
$17.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
| Rate for Payer: Networks By Design Commercial |
$18.76
|
| Rate for Payer: Prime Health Services Commercial |
$24.53
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
OP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$155.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.03
|
| Rate for Payer: BCBS Transplant Transplant |
$10.52
|
| Rate for Payer: Blue Shield of California Commercial |
$10.83
|
| Rate for Payer: Blue Shield of California EPN |
$8.52
|
| Rate for Payer: Caremore Medicare Advantage |
$17.83
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$11.22
|
| Rate for Payer: Cigna of CA PPO |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$14.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.78
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: IEHP medi-cal |
$29.42
|
| Rate for Payer: IEHP Medicare Advantage |
$17.83
|
| Rate for Payer: Innovage PACE Commercial |
$26.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.90
|
| Rate for Payer: Prime Health Services Medicare |
$18.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.52
|
| Rate for Payer: Riverside University Health MISP |
$19.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.44
|
| Rate for Payer: United Healthcare All Other HMO |
$14.44
|
| Rate for Payer: United Healthcare HMO Rider |
$14.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
IP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.90
|
|
|
HC SOM MCLON T. PROT U
|
Facility
OP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$32.62 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.62
|
| Rate for Payer: BCBS Transplant Transplant |
$2.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2.23
|
| Rate for Payer: Blue Shield of California EPN |
$1.75
|
| Rate for Payer: Caremore Medicare Advantage |
$3.67
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: IEHP medi-cal |
$6.06
|
| Rate for Payer: IEHP Medicare Advantage |
$3.67
|
| Rate for Payer: Innovage PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: Riverside University Health MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM MCLON T. PROT U
|
Facility
IP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Central Health Plan Commercial |
$2.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$13.50
|
| Rate for Payer: Blue Shield of California Commercial |
$13.90
|
| Rate for Payer: Blue Shield of California EPN |
$10.94
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$14.40
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
OP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: BCBS Transplant Transplant |
$13.50
|
| Rate for Payer: Blue Shield of California Commercial |
$13.90
|
| Rate for Payer: Blue Shield of California EPN |
$10.94
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$14.40
|
| Rate for Payer: Cigna of CA PPO |
$16.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$16.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: IEHP medi-cal |
$21.25
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Innovage PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: Riverside University Health MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
IP
|
$22.50
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$20.25 |
| Rate for Payer: Cash Price |
$10.13
|
| Rate for Payer: Central Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.00
|
| Rate for Payer: Galaxy Health WC |
$19.12
|
| Rate for Payer: Global Benefits Group Commercial |
$13.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$16.88
|
| Rate for Payer: Networks By Design Commercial |
$14.62
|
| Rate for Payer: Prime Health Services Commercial |
$19.12
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
OP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$132.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.32
|
| Rate for Payer: BCBS Transplant Transplant |
$21.05
|
| Rate for Payer: Blue Shield of California Commercial |
$21.68
|
| Rate for Payer: Blue Shield of California EPN |
$17.05
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Central Health Plan Commercial |
$28.06
|
| Rate for Payer: Cigna of CA HMO |
$22.45
|
| Rate for Payer: Cigna of CA PPO |
$25.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.03
|
| Rate for Payer: Galaxy Health WC |
$29.82
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.57
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.31
|
| Rate for Payer: IEHP medi-cal |
$12.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
| Rate for Payer: Networks By Design Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$29.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.05
|
| Rate for Payer: Riverside University Health MISP |
$14.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.54
|
| Rate for Payer: United Healthcare All Other HMO |
$17.54
|
| Rate for Payer: United Healthcare HMO Rider |
$17.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$29.82
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
IP
|
$35.08
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Cash Price |
$15.79
|
| Rate for Payer: Central Health Plan Commercial |
$28.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.03
|
| Rate for Payer: Galaxy Health WC |
$29.82
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$26.31
|
| Rate for Payer: Networks By Design Commercial |
$22.80
|
| Rate for Payer: Prime Health Services Commercial |
$29.82
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
OP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$129.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$81.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$52.81
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$52.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.04
|
| Rate for Payer: BCBS Transplant Transplant |
$57.61
|
| Rate for Payer: Blue Shield of California Commercial |
$59.33
|
| Rate for Payer: Blue Shield of California EPN |
$46.66
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.81
|
| Rate for Payer: Cigna of CA HMO |
$61.45
|
| Rate for Payer: Cigna of CA PPO |
$71.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.61
|
| Rate for Payer: Global Benefits Group Commercial |
$57.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.41
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$72.01
|
| Rate for Payer: IEHP medi-cal |
$33.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
| Rate for Payer: Networks By Design Commercial |
$62.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$57.61
|
| Rate for Payer: Riverside University Health MISP |
$38.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48.00
|
| Rate for Payer: United Healthcare HMO Rider |
$48.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.61
|
| Rate for Payer: Vantage Medical Group Senior |
$81.61
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
IP
|
$96.01
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.41 |
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.61
|
| Rate for Payer: Global Benefits Group Commercial |
$57.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.01
|
| Rate for Payer: Networks By Design Commercial |
$62.41
|
| Rate for Payer: Prime Health Services Commercial |
$81.61
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
IP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Central Health Plan Commercial |
$18.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$17.56
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
OP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$132.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.32
|
| Rate for Payer: BCBS Transplant Transplant |
$14.05
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.38
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Central Health Plan Commercial |
$18.74
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$17.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.56
|
| Rate for Payer: IEHP medi-cal |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$17.56
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.05
|
| Rate for Payer: Riverside University Health MISP |
$9.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.91
|
| Rate for Payer: Vantage Medical Group Senior |
$19.91
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
OP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.99
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.60
|
| Rate for Payer: BCBS Transplant Transplant |
$29.44
|
| Rate for Payer: Blue Shield of California Commercial |
$30.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.85
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Central Health Plan Commercial |
$39.26
|
| Rate for Payer: Cigna of CA HMO |
$31.40
|
| Rate for Payer: Cigna of CA PPO |
$36.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.16
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$36.80
|
| Rate for Payer: IEHP medi-cal |
$17.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$29.44
|
| Rate for Payer: Riverside University Health MISP |
$19.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.54
|
| Rate for Payer: United Healthcare All Other HMO |
$24.54
|
| Rate for Payer: United Healthcare HMO Rider |
$24.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.71
|
| Rate for Payer: Vantage Medical Group Senior |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
IP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Cash Price |
$22.08
|
| Rate for Payer: Central Health Plan Commercial |
$39.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
IP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$36.84 |
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Central Health Plan Commercial |
$32.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.37
|
| Rate for Payer: Galaxy Health WC |
$34.79
|
| Rate for Payer: Global Benefits Group Commercial |
$24.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$26.60
|
| Rate for Payer: Prime Health Services Commercial |
$34.79
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
OP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.51
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$22.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.60
|
| Rate for Payer: BCBS Transplant Transplant |
$24.56
|
| Rate for Payer: Blue Shield of California Commercial |
$25.29
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Central Health Plan Commercial |
$32.74
|
| Rate for Payer: Cigna of CA HMO |
$26.20
|
| Rate for Payer: Cigna of CA PPO |
$30.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.37
|
| Rate for Payer: Galaxy Health WC |
$34.79
|
| Rate for Payer: Global Benefits Group Commercial |
$24.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.84
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30.70
|
| Rate for Payer: IEHP medi-cal |
$14.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$26.60
|
| Rate for Payer: Prime Health Services Commercial |
$34.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24.56
|
| Rate for Payer: Riverside University Health MISP |
$16.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.79
|
| Rate for Payer: Vantage Medical Group Senior |
$34.79
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$153.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$99.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.52
|
| Rate for Payer: BCBS Transplant Transplant |
$108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$111.24
|
| Rate for Payer: Blue Shield of California EPN |
$87.48
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Central Health Plan Commercial |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$115.20
|
| Rate for Payer: Cigna of CA PPO |
$133.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.00
|
| Rate for Payer: Galaxy Health WC |
$153.00
|
| Rate for Payer: Global Benefits Group Commercial |
$108.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$135.00
|
| Rate for Payer: IEHP medi-cal |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$135.00
|
| Rate for Payer: Networks By Design Commercial |
$117.00
|
| Rate for Payer: Prime Health Services Commercial |
$153.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: Riverside University Health MISP |
$72.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.00
|
| Rate for Payer: Vantage Medical Group Senior |
$153.00
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
OP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$201.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$64.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$41.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$41.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.62
|
| Rate for Payer: BCBS Transplant Transplant |
$45.66
|
| Rate for Payer: Blue Shield of California Commercial |
$47.03
|
| Rate for Payer: Blue Shield of California EPN |
$36.98
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.68
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.08
|
| Rate for Payer: IEHP medi-cal |
$26.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.46
|
| Rate for Payer: Prime Health Services Commercial |
$64.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: Riverside University Health MISP |
$30.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.68
|
| Rate for Payer: Vantage Medical Group Senior |
$64.68
|
|
