|
HC SOM PENICILLIN V IGE
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900912842
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.88
|
| Rate for Payer: Blue Shield of California EPN |
$1.89
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM PERNIC ANEM CASC B12
|
Facility
|
OP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$109.66 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.26
|
| Rate for Payer: Blue Shield of California Commercial |
$48.12
|
| Rate for Payer: Blue Shield of California EPN |
$31.47
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Central Health Plan Commercial |
$63.42
|
| Rate for Payer: Cigna of CA HMO |
$50.74
|
| Rate for Payer: Cigna of CA PPO |
$58.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.36
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$67.39
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: InnovAge PACE Commercial |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$59.46
|
| Rate for Payer: Networks By Design Commercial |
$51.53
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.08
|
| Rate for Payer: Prime Health Services Commercial |
$67.39
|
| Rate for Payer: Prime Health Services Medicare |
$15.98
|
| Rate for Payer: Riverside University Health System MISP |
$16.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC SOM PERNIC ANEM CASC B12
|
Facility
|
IP
|
$79.28
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900914690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$71.35 |
| Rate for Payer: Adventist Health Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Central Health Plan Commercial |
$63.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.71
|
| Rate for Payer: EPIC Health Plan Senior |
$31.71
|
| Rate for Payer: Galaxy Health WC |
$67.39
|
| Rate for Payer: Global Benefits Group Commercial |
$47.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.86
|
| Rate for Payer: Multiplan Commercial |
$59.46
|
| Rate for Payer: Networks By Design Commercial |
$51.53
|
| Rate for Payer: Prime Health Services Commercial |
$67.39
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.05
|
| Rate for Payer: Blue Shield of California Commercial |
$37.03
|
| Rate for Payer: Blue Shield of California EPN |
$24.22
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: InnovAge PACE Commercial |
$30.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.70
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Riverside University Health System MISP |
$24.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.85
|
| Rate for Payer: Vantage Medical Group Senior |
$51.85
|
|
|
HC SOM PHENCYCLIDINE CONFIRM, U
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912920
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Senior |
$24.40
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.20
|
| Rate for Payer: Multiplan Commercial |
$45.75
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
|
|
HC SOM PHENOBARBITAL LEVEL
|
Facility
|
OP
|
$23.99
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$83.16 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.88
|
| Rate for Payer: Blue Shield of California Commercial |
$14.56
|
| Rate for Payer: Blue Shield of California EPN |
$9.52
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Central Health Plan Commercial |
$19.19
|
| Rate for Payer: Cigna of CA HMO |
$15.35
|
| Rate for Payer: Cigna of CA PPO |
$17.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Senior |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$20.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.30
|
| Rate for Payer: InnovAge PACE Commercial |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$15.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$20.39
|
| Rate for Payer: Prime Health Services Medicare |
$16.22
|
| Rate for Payer: Riverside University Health System MISP |
$16.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.39
|
| Rate for Payer: United Healthcare All Other HMO |
$12.39
|
| Rate for Payer: United Healthcare HMO Rider |
$12.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.39
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.83
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC SOM PHENOBARBITAL LEVEL
|
Facility
|
IP
|
$23.99
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
900912658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.59 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Central Health Plan Commercial |
$19.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.39
|
| Rate for Payer: Global Benefits Group Commercial |
$14.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$17.99
|
| Rate for Payer: Networks By Design Commercial |
$15.59
|
| Rate for Payer: Prime Health Services Commercial |
$20.39
|
|
|
HC SOM PHI 2PROPSA
|
Facility
|
IP
|
$29.20
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900915520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$26.28 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: Central Health Plan Commercial |
$23.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$11.68
|
| Rate for Payer: Galaxy Health WC |
$24.82
|
| Rate for Payer: Global Benefits Group Commercial |
$17.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$21.90
|
| Rate for Payer: Networks By Design Commercial |
$18.98
|
| Rate for Payer: Prime Health Services Commercial |
$24.82
|
|
|
HC SOM PHI 2PROPSA
|
Facility
|
OP
|
$29.20
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
900915520
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$151.39 |
| Rate for Payer: Adventist Health Commercial |
$5.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$151.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.72
|
| Rate for Payer: Blue Shield of California Commercial |
$17.72
|
| Rate for Payer: Blue Shield of California EPN |
$11.59
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: Cash Price |
$29.20
|
| Rate for Payer: Central Health Plan Commercial |
$23.36
|
| Rate for Payer: Cigna of CA HMO |
$18.69
|
| Rate for Payer: Cigna of CA PPO |
$21.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$24.82
|
| Rate for Payer: Global Benefits Group Commercial |
$17.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: InnovAge PACE Commercial |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$21.90
|
| Rate for Payer: Networks By Design Commercial |
$18.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.81
|
| Rate for Payer: Prime Health Services Commercial |
$24.82
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Riverside University Health System MISP |
$22.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM PHI FREE PSA
|
Facility
|
IP
|
$25.80
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900915519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$23.22 |
| Rate for Payer: Adventist Health Commercial |
$5.16
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Central Health Plan Commercial |
$20.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.32
|
| Rate for Payer: EPIC Health Plan Senior |
$10.32
|
| Rate for Payer: Galaxy Health WC |
$21.93
|
| Rate for Payer: Global Benefits Group Commercial |
$15.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$19.35
|
| Rate for Payer: Networks By Design Commercial |
$16.77
|
| Rate for Payer: Prime Health Services Commercial |
$21.93
|
|
|
HC SOM PHI FREE PSA
|
Facility
|
OP
|
$25.80
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900915519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$133.22 |
| Rate for Payer: Adventist Health Commercial |
$5.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.66
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Central Health Plan Commercial |
$20.64
|
| Rate for Payer: Cigna of CA HMO |
$16.51
|
| Rate for Payer: Cigna of CA PPO |
$19.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$21.93
|
| Rate for Payer: Global Benefits Group Commercial |
$15.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$19.35
|
| Rate for Payer: Networks By Design Commercial |
$16.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$21.93
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM PHOSPHATIDYL ETHANOL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
900915352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC SOM PHOSPHATIDYL ETHANOL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
900915352
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.31
|
| Rate for Payer: Blue Shield of California Commercial |
$42.49
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: InnovAge PACE Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC SOM PHOSPHOLIPID AB IGA
|
Facility
|
OP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$105.06 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.32
|
| Rate for Payer: Blue Shield of California Commercial |
$14.63
|
| Rate for Payer: Blue Shield of California EPN |
$9.57
|
| Rate for Payer: Cash Price |
$24.10
|
| Rate for Payer: Cash Price |
$24.10
|
| Rate for Payer: Central Health Plan Commercial |
$19.28
|
| Rate for Payer: Cigna of CA HMO |
$15.42
|
| Rate for Payer: Cigna of CA PPO |
$17.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Senior |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$20.48
|
| Rate for Payer: Global Benefits Group Commercial |
$14.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: InnovAge PACE Commercial |
$38.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$18.07
|
| Rate for Payer: Networks By Design Commercial |
$15.66
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.45
|
| Rate for Payer: Prime Health Services Commercial |
$20.48
|
| Rate for Payer: Prime Health Services Medicare |
$26.98
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM PHOSPHOLIPID AB IGA
|
Facility
|
IP
|
$24.10
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
900914172
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$21.69 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$24.10
|
| Rate for Payer: Central Health Plan Commercial |
$19.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.48
|
| Rate for Payer: Global Benefits Group Commercial |
$14.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$18.07
|
| Rate for Payer: Networks By Design Commercial |
$15.66
|
| Rate for Payer: Prime Health Services Commercial |
$20.48
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
|
OP
|
$79.46
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$139.44 |
| Rate for Payer: Adventist Health Commercial |
$15.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.30
|
| Rate for Payer: Blue Shield of California Commercial |
$48.23
|
| Rate for Payer: Blue Shield of California EPN |
$31.55
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Central Health Plan Commercial |
$63.57
|
| Rate for Payer: Cigna of CA HMO |
$50.85
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.57
|
| Rate for Payer: InnovAge PACE Commercial |
$39.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.62
|
| Rate for Payer: Multiplan Commercial |
$59.59
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
| Rate for Payer: Riverside University Health System MISP |
$31.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.54
|
| Rate for Payer: Vantage Medical Group Senior |
$67.54
|
|
|
HC SOM PI-LINKD AG FLOW EA ADD'L
|
Facility
|
IP
|
$79.46
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914176
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$71.51 |
| Rate for Payer: Adventist Health Commercial |
$15.89
|
| Rate for Payer: Cash Price |
$79.46
|
| Rate for Payer: Central Health Plan Commercial |
$63.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: EPIC Health Plan Senior |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.89
|
| Rate for Payer: Multiplan Commercial |
$59.59
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
|
IP
|
$70.54
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$63.49 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: Central Health Plan Commercial |
$56.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.22
|
| Rate for Payer: EPIC Health Plan Senior |
$28.22
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Multiplan Commercial |
$52.91
|
| Rate for Payer: Networks By Design Commercial |
$45.85
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
|
|
HC SOM PI-LINKD AG FLOW TC 1 MRKR
|
Facility
|
OP
|
$70.54
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914173
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$14.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$457.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$283.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.59
|
| Rate for Payer: Blue Shield of California Commercial |
$42.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.00
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: Central Health Plan Commercial |
$56.43
|
| Rate for Payer: Cigna of CA HMO |
$45.15
|
| Rate for Payer: Cigna of CA PPO |
$52.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$59.96
|
| Rate for Payer: Global Benefits Group Commercial |
$42.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.49
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: InnovAge PACE Commercial |
$685.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$52.91
|
| Rate for Payer: Networks By Design Commercial |
$45.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$457.06
|
| Rate for Payer: Prime Health Services Commercial |
$59.96
|
| Rate for Payer: Prime Health Services Medicare |
$484.48
|
| Rate for Payer: Riverside University Health System MISP |
$502.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
|
IP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC SOM PIPERACILLIN LEVEL BA
|
Facility
|
OP
|
$106.40
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.49
|
| Rate for Payer: Blue Shield of California Commercial |
$64.58
|
| Rate for Payer: Blue Shield of California EPN |
$42.24
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: InnovAge PACE Commercial |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Riverside University Health System MISP |
$42.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC SOM PKHD1 GENE
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$943.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
|
|
HC SOM PKHD1 GENE
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
900914705
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$305.00 |
| Max. Negotiated Rate |
$1,372.50 |
| Rate for Payer: Adventist Health Commercial |
$305.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$838.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,143.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$738.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$895.63
|
| Rate for Payer: Blue Shield of California Commercial |
$925.67
|
| Rate for Payer: Blue Shield of California EPN |
$605.42
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,220.00
|
| Rate for Payer: Cigna of CA HMO |
$976.00
|
| Rate for Payer: Cigna of CA PPO |
$1,128.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,296.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,296.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$610.00
|
| Rate for Payer: Galaxy Health WC |
$1,296.25
|
| Rate for Payer: Global Benefits Group Commercial |
$915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,372.50
|
| Rate for Payer: InnovAge PACE Commercial |
$762.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$943.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,067.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,067.50
|
| Rate for Payer: Multiplan Commercial |
$1,143.75
|
| Rate for Payer: Networks By Design Commercial |
$991.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,296.25
|
| Rate for Payer: Riverside University Health System MISP |
$610.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.50
|
| Rate for Payer: United Healthcare All Other HMO |
$762.50
|
| Rate for Payer: United Healthcare HMO Rider |
$762.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$762.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,296.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,296.25
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$47.61 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.66
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$6.53
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.53
|
| Rate for Payer: InnovAge PACE Commercial |
$9.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.53
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.92
|
| Rate for Payer: Riverside University Health System MISP |
$7.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.29
|
| Rate for Payer: United Healthcare All Other HMO |
$5.29
|
| Rate for Payer: United Healthcare HMO Rider |
$5.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$6.53
|
|
|
HC SOM PLASMINOGEN ACTIVITY
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
900911325
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
