|
HC SOM CYSTIC FIBROSIS GENE MUTATION
|
Facility
|
IP
|
$130.90
|
|
|
Service Code
|
CPT 81222
|
| Hospital Charge Code |
900915427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$117.81 |
| Rate for Payer: Adventist Health Commercial |
$26.18
|
| Rate for Payer: Cash Price |
$130.90
|
| Rate for Payer: Central Health Plan Commercial |
$104.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.36
|
| Rate for Payer: EPIC Health Plan Senior |
$52.36
|
| Rate for Payer: Galaxy Health WC |
$111.27
|
| Rate for Payer: Global Benefits Group Commercial |
$78.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.18
|
| Rate for Payer: Multiplan Commercial |
$98.17
|
| Rate for Payer: Networks By Design Commercial |
$85.08
|
| Rate for Payer: Prime Health Services Commercial |
$111.27
|
|
|
HC SOM DCP 83951
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| 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 DCP 83951
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83951
|
| Hospital Charge Code |
900914920
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$649.17 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$64.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$466.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$649.17
|
| 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 |
$96.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.28
|
| Rate for Payer: EPIC Health Plan Senior |
$70.85
|
| 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 |
$105.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$64.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$86.31
|
| 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 |
$64.41
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Medicare |
$68.27
|
| Rate for Payer: Riverside University Health System MISP |
$70.85
|
| 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 |
$52.17
|
| Rate for Payer: United Healthcare All Other HMO |
$52.17
|
| Rate for Payer: United Healthcare HMO Rider |
$52.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$64.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.85
|
| Rate for Payer: Vantage Medical Group Senior |
$64.41
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.32
|
| Rate for Payer: Blue Shield of California Commercial |
$56.13
|
| Rate for Payer: Blue Shield of California EPN |
$35.37
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: Cigna of CA HMO |
$57.02
|
| Rate for Payer: Cigna of CA PPO |
$65.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DENGUE FEVER AB IGG
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900911637
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$80.19 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
IP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$80.19 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
|
|
HC SOM DENGUE FEVER AB IGM
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
900912614
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.32
|
| Rate for Payer: Blue Shield of California Commercial |
$56.13
|
| Rate for Payer: Blue Shield of California EPN |
$35.37
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$71.28
|
| Rate for Payer: Cigna of CA HMO |
$57.02
|
| Rate for Payer: Cigna of CA PPO |
$65.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$75.73
|
| Rate for Payer: Global Benefits Group Commercial |
$53.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.19
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.91
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$75.73
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM DESMOGLEIN 1
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| 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 |
$39.38
|
| Rate for Payer: Blue Shield of California EPN |
$24.81
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$40.00
|
| Rate for Payer: Cigna of CA PPO |
$46.25
|
| 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 |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| 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 |
$39.69
|
| 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 |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
| 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 |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.50
|
| 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 DESMOGLEIN 1
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25.00
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
IP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.00
|
| Rate for Payer: EPIC Health Plan Senior |
$25.00
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.50
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
|
|
HC SOM DESMOGLEIN 3
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900914662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$236.61 |
| Rate for Payer: Adventist Health Commercial |
$12.50
|
| 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 |
$39.38
|
| Rate for Payer: Blue Shield of California EPN |
$24.81
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Central Health Plan Commercial |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$40.00
|
| Rate for Payer: Cigna of CA PPO |
$46.25
|
| 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 |
$43.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.02
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$53.12
|
| Rate for Payer: Global Benefits Group Commercial |
$37.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.25
|
| 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 |
$39.69
|
| 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 |
$12.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$46.88
|
| Rate for Payer: Networks By Design Commercial |
$40.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$53.12
|
| 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 |
$37.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.50
|
| 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 DESYREL (TRAZODONE)
|
Facility
|
OP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$173.63 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.69
|
| 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 |
$44.26
|
| Rate for Payer: Blue Shield of California EPN |
$27.89
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| Rate for Payer: Cigna of CA HMO |
$44.96
|
| Rate for Payer: Cigna of CA PPO |
$51.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.17
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
| Rate for Payer: Riverside University Health System MISP |
$28.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.12
|
| Rate for Payer: United Healthcare All Other HMO |
$35.12
|
| Rate for Payer: United Healthcare HMO Rider |
$35.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.71
|
| Rate for Payer: Vantage Medical Group Senior |
$59.71
|
|
|
HC SOM DESYREL (TRAZODONE)
|
Facility
|
IP
|
$70.25
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
900911223
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Central Health Plan Commercial |
$56.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$59.71
|
| Rate for Payer: Global Benefits Group Commercial |
$42.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.05
|
| Rate for Payer: Multiplan Commercial |
$52.69
|
| Rate for Payer: Networks By Design Commercial |
$45.66
|
| Rate for Payer: Prime Health Services Commercial |
$59.71
|
|
|
HC SOM DHEA
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8.40
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
|
|
HC SOM DHEA
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900911115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$255.61 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.23
|
| Rate for Payer: Blue Shield of California EPN |
$8.34
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.70
|
| Rate for Payer: EPIC Health Plan Senior |
$27.80
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.27
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Prime Health Services Medicare |
$26.79
|
| Rate for Payer: Riverside University Health System MISP |
$27.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.47
|
| Rate for Payer: United Healthcare All Other HMO |
$20.47
|
| Rate for Payer: United Healthcare HMO Rider |
$20.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$39.32 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Central Health Plan Commercial |
$34.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Senior |
$17.48
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
|
|
HC SOM DIAB EVAL IA-2 AB
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.52
|
| Rate for Payer: Blue Shield of California Commercial |
$27.52
|
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Central Health Plan Commercial |
$34.95
|
| Rate for Payer: Cigna of CA HMO |
$27.96
|
| Rate for Payer: Cigna of CA PPO |
$32.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Riverside University Health System MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
IP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$39.32 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Central Health Plan Commercial |
$34.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Senior |
$17.48
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
|
|
HC SOM DIAB EVAL ZN T8 AB
|
Facility
|
OP
|
$43.69
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
900915421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$155.52 |
| Rate for Payer: Adventist Health Commercial |
$8.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.52
|
| Rate for Payer: Blue Shield of California Commercial |
$27.52
|
| Rate for Payer: Blue Shield of California EPN |
$17.34
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Cash Price |
$43.69
|
| Rate for Payer: Central Health Plan Commercial |
$34.95
|
| Rate for Payer: Cigna of CA HMO |
$27.96
|
| Rate for Payer: Cigna of CA PPO |
$32.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.89
|
| Rate for Payer: EPIC Health Plan Senior |
$25.93
|
| Rate for Payer: Galaxy Health WC |
$37.14
|
| Rate for Payer: Global Benefits Group Commercial |
$26.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$32.77
|
| Rate for Payer: Networks By Design Commercial |
$28.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.57
|
| Rate for Payer: Prime Health Services Commercial |
$37.14
|
| Rate for Payer: Prime Health Services Medicare |
$24.98
|
| Rate for Payer: Riverside University Health System MISP |
$25.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.09
|
| Rate for Payer: United Healthcare All Other HMO |
$19.09
|
| Rate for Payer: United Healthcare HMO Rider |
$19.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.93
|
| Rate for Payer: Vantage Medical Group Senior |
$23.57
|
|
|
HC SOM DIAZEPAM (VALIUM)
|
Facility
|
OP
|
$43.73
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$8.75
|
| 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 |
$27.55
|
| Rate for Payer: Blue Shield of California EPN |
$17.36
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Central Health Plan Commercial |
$34.98
|
| Rate for Payer: Cigna of CA HMO |
$27.99
|
| Rate for Payer: Cigna of CA PPO |
$32.36
|
| 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 |
$30.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$37.17
|
| Rate for Payer: Global Benefits Group Commercial |
$26.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.36
|
| 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 |
$27.77
|
| 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 |
$8.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$28.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$37.17
|
| 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 |
$26.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.24
|
| 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 DIAZEPAM (VALIUM)
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$39.36 |
| Rate for Payer: Adventist Health Commercial |
$8.75
|
| Rate for Payer: Cash Price |
$43.73
|
| Rate for Payer: Central Health Plan Commercial |
$34.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.49
|
| Rate for Payer: EPIC Health Plan Senior |
$17.49
|
| Rate for Payer: Galaxy Health WC |
$37.17
|
| Rate for Payer: Global Benefits Group Commercial |
$26.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$28.42
|
| Rate for Payer: Prime Health Services Commercial |
$37.17
|
|
|
HC SOM DIHYDROTESTERONE
|
Facility
|
OP
|
$43.87
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$204.54 |
| Rate for Payer: Adventist Health Commercial |
$8.77
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$169.65
|
| 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 |
$147.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.54
|
| Rate for Payer: Blue Shield of California Commercial |
$27.64
|
| Rate for Payer: Blue Shield of California EPN |
$17.42
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Central Health Plan Commercial |
$35.10
|
| Rate for Payer: Cigna of CA HMO |
$28.08
|
| Rate for Payer: Cigna of CA PPO |
$32.46
|
| 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 |
$30.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.21
|
| Rate for Payer: Galaxy Health WC |
$37.29
|
| Rate for Payer: Global Benefits Group Commercial |
$26.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.48
|
| 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 |
$27.86
|
| 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 |
$8.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$32.90
|
| Rate for Payer: Networks By Design Commercial |
$28.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.28
|
| Rate for Payer: Prime Health Services Commercial |
$37.29
|
| 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 |
$26.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.32
|
| 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 DIHYDROTESTERONE
|
Facility
|
IP
|
$43.87
|
|
|
Service Code
|
CPT 82642
|
| Hospital Charge Code |
900911013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Adventist Health Commercial |
$8.77
|
| Rate for Payer: Cash Price |
$43.87
|
| Rate for Payer: Central Health Plan Commercial |
$35.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.55
|
| Rate for Payer: EPIC Health Plan Senior |
$17.55
|
| Rate for Payer: Galaxy Health WC |
$37.29
|
| Rate for Payer: Global Benefits Group Commercial |
$26.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.77
|
| Rate for Payer: Multiplan Commercial |
$32.90
|
| Rate for Payer: Networks By Design Commercial |
$28.52
|
| Rate for Payer: Prime Health Services Commercial |
$37.29
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
IP
|
$14.36
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Central Health Plan Commercial |
$11.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.74
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$12.21
|
| Rate for Payer: Global Benefits Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$10.77
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: Prime Health Services Commercial |
$12.21
|
|
|
HC SOM DILANTIN FREE
|
Facility
|
OP
|
$14.36
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
900911414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$141.76 |
| Rate for Payer: Adventist Health Commercial |
$2.87
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.76
|
| Rate for Payer: Blue Shield of California Commercial |
$9.05
|
| Rate for Payer: Blue Shield of California EPN |
$5.70
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Central Health Plan Commercial |
$11.49
|
| Rate for Payer: Cigna of CA HMO |
$9.19
|
| Rate for Payer: Cigna of CA PPO |
$10.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Senior |
$15.14
|
| Rate for Payer: Galaxy Health WC |
$12.21
|
| Rate for Payer: Global Benefits Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.44
|
| Rate for Payer: Multiplan Commercial |
$10.77
|
| Rate for Payer: Networks By Design Commercial |
$9.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.21
|
| Rate for Payer: Prime Health Services Medicare |
$14.59
|
| Rate for Payer: Riverside University Health System MISP |
$15.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.14
|
| Rate for Payer: United Healthcare All Other HMO |
$11.14
|
| Rate for Payer: United Healthcare HMO Rider |
$11.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.14
|
| Rate for Payer: Vantage Medical Group Senior |
$13.76
|
|
