|
HC SOM AMOBARBITAL
|
Facility
|
IP
|
$148.31
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.66 |
| Max. Negotiated Rate |
$133.48 |
| Rate for Payer: Adventist Health Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Central Health Plan Commercial |
$118.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.32
|
| Rate for Payer: EPIC Health Plan Senior |
$59.32
|
| Rate for Payer: Galaxy Health WC |
$126.06
|
| Rate for Payer: Global Benefits Group Commercial |
$88.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$111.23
|
| Rate for Payer: Networks By Design Commercial |
$96.40
|
| Rate for Payer: Prime Health Services Commercial |
$126.06
|
|
|
HC SOM AMOBARBITAL
|
Facility
|
OP
|
$148.31
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910550
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$29.66
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$93.44
|
| Rate for Payer: Blue Shield of California EPN |
$58.88
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Cash Price |
$148.31
|
| Rate for Payer: Central Health Plan Commercial |
$118.65
|
| Rate for Payer: Cigna of CA HMO |
$94.92
|
| Rate for Payer: Cigna of CA PPO |
$109.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$126.06
|
| Rate for Payer: Global Benefits Group Commercial |
$88.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.48
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$94.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$111.23
|
| Rate for Payer: Networks By Design Commercial |
$96.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$126.06
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM AMOXAPINE
|
Facility
|
OP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$124.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.63
|
| Rate for Payer: Blue Shield of California Commercial |
$41.24
|
| Rate for Payer: Blue Shield of California EPN |
$25.99
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Central Health Plan Commercial |
$52.37
|
| Rate for Payer: Cigna of CA HMO |
$41.89
|
| Rate for Payer: Cigna of CA PPO |
$48.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.82
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
| Rate for Payer: Riverside University Health System MISP |
$26.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.73
|
| Rate for Payer: United Healthcare All Other HMO |
$32.73
|
| Rate for Payer: United Healthcare HMO Rider |
$32.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.64
|
| Rate for Payer: Vantage Medical Group Senior |
$55.64
|
|
|
HC SOM AMOXAPINE
|
Facility
|
IP
|
$65.46
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
900911071
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$58.91 |
| Rate for Payer: Adventist Health Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Central Health Plan Commercial |
$52.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.18
|
| Rate for Payer: EPIC Health Plan Senior |
$26.18
|
| Rate for Payer: Galaxy Health WC |
$55.64
|
| Rate for Payer: Global Benefits Group Commercial |
$39.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Networks By Design Commercial |
$42.55
|
| Rate for Payer: Prime Health Services Commercial |
$55.64
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Adventist Health Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$32.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16.20
|
| Rate for Payer: Galaxy Health WC |
$34.42
|
| Rate for Payer: Global Benefits Group Commercial |
$24.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$30.38
|
| Rate for Payer: Networks By Design Commercial |
$26.32
|
| Rate for Payer: Prime Health Services Commercial |
$34.42
|
|
|
HC SOM AMPHETAMINE QUANT
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900910720
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$802.17 |
| Rate for Payer: Adventist Health Commercial |
$8.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$114.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$577.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$802.17
|
| Rate for Payer: Blue Shield of California Commercial |
$25.52
|
| Rate for Payer: Blue Shield of California EPN |
$16.08
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$25.92
|
| Rate for Payer: Cigna of CA PPO |
$29.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.81
|
| Rate for Payer: EPIC Health Plan Senior |
$125.87
|
| Rate for Payer: Galaxy Health WC |
$34.42
|
| Rate for Payer: Global Benefits Group Commercial |
$24.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$187.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$114.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.34
|
| Rate for Payer: Multiplan Commercial |
$30.38
|
| Rate for Payer: Networks By Design Commercial |
$26.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$114.43
|
| Rate for Payer: Prime Health Services Commercial |
$34.42
|
| Rate for Payer: Prime Health Services Medicare |
$121.30
|
| Rate for Payer: Riverside University Health System MISP |
$125.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.69
|
| Rate for Payer: United Healthcare All Other HMO |
$92.69
|
| Rate for Payer: United Healthcare HMO Rider |
$92.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$114.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Vantage Medical Group Senior |
$114.43
|
|
|
HC SOM AMYLASE BF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM AMYLASE BF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
900914004
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$65.64 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.64
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.69
|
| Rate for Payer: EPIC Health Plan Senior |
$7.13
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.48
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$6.87
|
| Rate for Payer: Riverside University Health System MISP |
$7.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.25
|
| Rate for Payer: United Healthcare HMO Rider |
$5.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.13
|
| Rate for Payer: Vantage Medical Group Senior |
$6.48
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
OP
|
$20.68
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$295.99 |
| Rate for Payer: Adventist Health Commercial |
$4.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$295.99
|
| Rate for Payer: Blue Shield of California Commercial |
$13.03
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Central Health Plan Commercial |
$16.54
|
| Rate for Payer: Cigna of CA HMO |
$13.24
|
| Rate for Payer: Cigna of CA PPO |
$15.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.21
|
| Rate for Payer: Galaxy Health WC |
$17.58
|
| Rate for Payer: Global Benefits Group Commercial |
$12.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$15.51
|
| Rate for Payer: Networks By Design Commercial |
$13.44
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.28
|
| Rate for Payer: Prime Health Services Commercial |
$17.58
|
| Rate for Payer: Prime Health Services Medicare |
$31.04
|
| Rate for Payer: Riverside University Health System MISP |
$32.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.71
|
| Rate for Payer: United Healthcare All Other HMO |
$23.71
|
| Rate for Payer: United Healthcare HMO Rider |
$23.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM ANDROSTENEDIONE
|
Facility
|
IP
|
$20.68
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900911011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.14
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Central Health Plan Commercial |
$16.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.27
|
| Rate for Payer: EPIC Health Plan Senior |
$8.27
|
| Rate for Payer: Galaxy Health WC |
$17.58
|
| Rate for Payer: Global Benefits Group Commercial |
$12.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$15.51
|
| Rate for Payer: Networks By Design Commercial |
$13.44
|
| Rate for Payer: Prime Health Services Commercial |
$17.58
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM ANGIOTENSIN 1 CONVERTING ENZYM
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900911119
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$147.62 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.09
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.60
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$15.48
|
| Rate for Payer: Riverside University Health System MISP |
$16.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
OP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$147.62 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.62
|
| Rate for Payer: Blue Shield of California Commercial |
$43.16
|
| Rate for Payer: Blue Shield of California EPN |
$27.19
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Central Health Plan Commercial |
$54.80
|
| Rate for Payer: Cigna of CA HMO |
$43.84
|
| Rate for Payer: Cigna of CA PPO |
$50.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.09
|
| Rate for Payer: EPIC Health Plan Senior |
$16.06
|
| Rate for Payer: Galaxy Health WC |
$58.23
|
| Rate for Payer: Global Benefits Group Commercial |
$41.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$51.38
|
| Rate for Payer: Networks By Design Commercial |
$44.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.60
|
| Rate for Payer: Prime Health Services Commercial |
$58.23
|
| Rate for Payer: Prime Health Services Medicare |
$15.48
|
| Rate for Payer: Riverside University Health System MISP |
$16.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.83
|
| Rate for Payer: United Healthcare All Other HMO |
$11.83
|
| Rate for Payer: United Healthcare HMO Rider |
$11.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.06
|
| Rate for Payer: Vantage Medical Group Senior |
$14.60
|
|
|
HC SOM ANGIOTENSIN CONVERT ENZ CS
|
Facility
|
IP
|
$68.50
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
900913826
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Adventist Health Commercial |
$13.70
|
| Rate for Payer: Cash Price |
$68.50
|
| Rate for Payer: Central Health Plan Commercial |
$54.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.40
|
| Rate for Payer: EPIC Health Plan Senior |
$27.40
|
| Rate for Payer: Galaxy Health WC |
$58.23
|
| Rate for Payer: Global Benefits Group Commercial |
$41.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.70
|
| Rate for Payer: Multiplan Commercial |
$51.38
|
| Rate for Payer: Networks By Design Commercial |
$44.52
|
| Rate for Payer: Prime Health Services Commercial |
$58.23
|
|
|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$344.60 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$33.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$344.60
|
| Rate for Payer: Blue Shield of California Commercial |
$56.70
|
| Rate for Payer: Blue Shield of California EPN |
$35.73
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$37.33
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$55.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.48
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$33.94
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Medicare |
$35.98
|
| Rate for Payer: Riverside University Health System MISP |
$37.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.50
|
| Rate for Payer: United Healthcare All Other HMO |
$27.50
|
| Rate for Payer: United Healthcare HMO Rider |
$27.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$33.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.33
|
| Rate for Payer: Vantage Medical Group Senior |
$33.94
|
|
|
HC SOM ANTI-DIURETIC HORMONE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
900911035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC SOM ANTI-GBM TITER AB
|
Facility
|
OP
|
$30.55
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$6.11
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.61
|
| Rate for Payer: Blue Shield of California Commercial |
$19.25
|
| Rate for Payer: Blue Shield of California EPN |
$12.13
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Central Health Plan Commercial |
$24.44
|
| Rate for Payer: Cigna of CA HMO |
$19.55
|
| Rate for Payer: Cigna of CA PPO |
$22.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$25.97
|
| Rate for Payer: Global Benefits Group Commercial |
$18.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$22.91
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$25.97
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SOM ANTI-GBM TITER AB
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900911188
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Adventist Health Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Central Health Plan Commercial |
$24.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.22
|
| Rate for Payer: EPIC Health Plan Senior |
$12.22
|
| Rate for Payer: Galaxy Health WC |
$25.97
|
| Rate for Payer: Global Benefits Group Commercial |
$18.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.11
|
| Rate for Payer: Multiplan Commercial |
$22.91
|
| Rate for Payer: Networks By Design Commercial |
$19.86
|
| Rate for Payer: Prime Health Services Commercial |
$25.97
|
|
|
HC SOM ANTI-LIVERKIDNEY MICROSOMAL AB
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911453
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
|
|
HC SOM ANTI-LIVERKIDNEY MICROSOMAL AB
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
900911453
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$148.10 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.10
|
| Rate for Payer: Blue Shield of California Commercial |
$8.51
|
| Rate for Payer: Blue Shield of California EPN |
$5.36
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$8.64
|
| Rate for Payer: Cigna of CA PPO |
$9.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.01
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.55
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
| Rate for Payer: Prime Health Services Medicare |
$15.42
|
| Rate for Payer: Riverside University Health System MISP |
$16.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.79
|
| Rate for Payer: United Healthcare All Other HMO |
$11.79
|
| Rate for Payer: United Healthcare HMO Rider |
$11.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.79
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.00
|
| Rate for Payer: Vantage Medical Group Senior |
$14.55
|
|
|
HC SOM ANTIMULLERIAN HORMONE, S
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
900912908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$201.44 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.90
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.72
|
| Rate for Payer: EPIC Health Plan Senior |
$42.48
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$66.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.62
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$40.94
|
| Rate for Payer: Riverside University Health System MISP |
$42.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.50
|
| Rate for Payer: United Healthcare All Other HMO |
$27.50
|
| Rate for Payer: United Healthcare HMO Rider |
$27.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC SOM ANTIMULLERIAN HORMONE, S
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
900912908
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM ANTI-NEUTROPHIL AB
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
900911211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$152.25 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.25
|
| Rate for Payer: Blue Shield of California Commercial |
$45.36
|
| Rate for Payer: Blue Shield of California EPN |
$28.58
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.55
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.05
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Riverside University Health System MISP |
$16.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.55
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM ANTI-NEUTROPHIL AB
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
900911211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Senior |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SOM ANTI-NEUTROPHIL CYTOPLASM ANTI
|
Facility
|
OP
|
$23.15
|
|
|
Service Code
|
CPT 86036
|
| Hospital Charge Code |
900910287
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$62.83 |
| Rate for Payer: Adventist Health Commercial |
$4.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.32
|
| Rate for Payer: Blue Shield of California Commercial |
$14.58
|
| Rate for Payer: Blue Shield of California EPN |
$9.19
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Central Health Plan Commercial |
$18.52
|
| Rate for Payer: Cigna of CA HMO |
$14.82
|
| Rate for Payer: Cigna of CA PPO |
$17.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$19.68
|
| Rate for Payer: Global Benefits Group Commercial |
$13.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$17.36
|
| Rate for Payer: Networks By Design Commercial |
$15.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$19.68
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
