|
HC SOM ENS TRIM46 IFA
|
Facility
|
OP
|
$34.06
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
900915474
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.81 |
| Max. Negotiated Rate |
$121.95 |
| Rate for Payer: Adventist Health Commercial |
$6.81
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.48
|
| 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 |
$87.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.95
|
| Rate for Payer: Blue Shield of California Commercial |
$21.46
|
| Rate for Payer: Blue Shield of California EPN |
$13.52
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Cash Price |
$34.06
|
| Rate for Payer: Central Health Plan Commercial |
$27.25
|
| Rate for Payer: Cigna of CA HMO |
$21.80
|
| Rate for Payer: Cigna of CA PPO |
$25.20
|
| 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 |
$23.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.88
|
| Rate for Payer: EPIC Health Plan Senior |
$13.26
|
| Rate for Payer: Galaxy Health WC |
$28.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$25.55
|
| Rate for Payer: Networks By Design Commercial |
$22.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$28.95
|
| 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 |
$20.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.44
|
| 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
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM ENTEROVIRUS PCR, BLOOD
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910691
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$347.26 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.26
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM ENTEROVIRUS PCR CSF
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
900910771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$347.26 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.26
|
| Rate for Payer: Blue Shield of California Commercial |
$28.35
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM ERYTHROPOIETIN
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
900911227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$188.75 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.75
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Blue Shield of California EPN |
$6.22
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Central Health Plan Commercial |
$12.54
|
| Rate for Payer: Cigna of CA HMO |
$10.04
|
| Rate for Payer: Cigna of CA PPO |
$11.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.67
|
| Rate for Payer: Galaxy Health WC |
$13.33
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.18
|
| Rate for Payer: Multiplan Commercial |
$11.76
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.79
|
| Rate for Payer: Prime Health Services Commercial |
$13.33
|
| Rate for Payer: Prime Health Services Medicare |
$19.92
|
| Rate for Payer: Riverside University Health System MISP |
$20.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.22
|
| Rate for Payer: United Healthcare All Other HMO |
$15.22
|
| Rate for Payer: United Healthcare HMO Rider |
$15.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.22
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.67
|
| Rate for Payer: Vantage Medical Group Senior |
$18.79
|
|
|
HC SOM ERYTHROPOIETIN
|
Facility
|
IP
|
$15.68
|
|
|
Service Code
|
CPT 82668
|
| Hospital Charge Code |
900911227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Adventist Health Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Central Health Plan Commercial |
$12.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.27
|
| Rate for Payer: EPIC Health Plan Senior |
$6.27
|
| Rate for Payer: Galaxy Health WC |
$13.33
|
| Rate for Payer: Global Benefits Group Commercial |
$9.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$11.76
|
| Rate for Payer: Networks By Design Commercial |
$10.19
|
| Rate for Payer: Prime Health Services Commercial |
$13.33
|
|
|
HC SOM ESTRADIOL
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
900911014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM ESTRADIOL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
900911014
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$326.63 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$32.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$237.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$234.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.63
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.30
|
| Rate for Payer: EPIC Health Plan Senior |
$35.53
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$52.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$32.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.28
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$34.24
|
| Rate for Payer: Riverside University Health System MISP |
$35.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Other HMO |
$26.16
|
| Rate for Payer: United Healthcare HMO Rider |
$26.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.16
|
| Rate for Payer: Upland Medical Group Pediatric |
$32.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.53
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC SOM ESTRIOL
|
Facility
|
OP
|
$19.88
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
900911036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$245.60 |
| Rate for Payer: Adventist Health Commercial |
$3.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$177.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$176.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.52
|
| Rate for Payer: Blue Shield of California EPN |
$7.89
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Central Health Plan Commercial |
$15.90
|
| Rate for Payer: Cigna of CA HMO |
$12.72
|
| Rate for Payer: Cigna of CA PPO |
$14.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.90
|
| Rate for Payer: EPIC Health Plan Senior |
$26.60
|
| Rate for Payer: Galaxy Health WC |
$16.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$14.91
|
| Rate for Payer: Networks By Design Commercial |
$12.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.18
|
| Rate for Payer: Prime Health Services Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Medicare |
$25.63
|
| Rate for Payer: Riverside University Health System MISP |
$26.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.58
|
| Rate for Payer: United Healthcare All Other HMO |
$19.58
|
| Rate for Payer: United Healthcare HMO Rider |
$19.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.60
|
| Rate for Payer: Vantage Medical Group Senior |
$24.18
|
|
|
HC SOM ESTRIOL
|
Facility
|
IP
|
$19.88
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
900911036
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Adventist Health Commercial |
$3.98
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Central Health Plan Commercial |
$15.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: EPIC Health Plan Senior |
$7.95
|
| Rate for Payer: Galaxy Health WC |
$16.90
|
| Rate for Payer: Global Benefits Group Commercial |
$11.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$14.91
|
| Rate for Payer: Networks By Design Commercial |
$12.92
|
| Rate for Payer: Prime Health Services Commercial |
$16.90
|
|
|
HC SOM ESTRONE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
900911482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ESTRONE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
900911482
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$252.41 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.41
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.17
|
| Rate for Payer: EPIC Health Plan Senior |
$27.45
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$40.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.43
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.95
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$26.45
|
| Rate for Payer: Riverside University Health System MISP |
$27.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.21
|
| Rate for Payer: United Healthcare All Other HMO |
$20.21
|
| Rate for Payer: United Healthcare HMO Rider |
$20.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Vantage Medical Group Senior |
$24.95
|
|
|
HC SOM ETHANOL, U
|
Facility
|
OP
|
$49.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$104.86 |
| Rate for Payer: Adventist Health Commercial |
$9.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.86
|
| Rate for Payer: Blue Shield of California Commercial |
$31.44
|
| Rate for Payer: Blue Shield of California EPN |
$19.81
|
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Central Health Plan Commercial |
$39.92
|
| Rate for Payer: Cigna of CA HMO |
$31.94
|
| Rate for Payer: Cigna of CA PPO |
$36.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.96
|
| Rate for Payer: EPIC Health Plan Senior |
$19.96
|
| Rate for Payer: Galaxy Health WC |
$42.41
|
| Rate for Payer: Global Benefits Group Commercial |
$29.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.93
|
| Rate for Payer: Multiplan Commercial |
$37.42
|
| Rate for Payer: Networks By Design Commercial |
$32.44
|
| Rate for Payer: Prime Health Services Commercial |
$42.41
|
| Rate for Payer: Riverside University Health System MISP |
$19.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.95
|
| Rate for Payer: United Healthcare All Other HMO |
$24.95
|
| Rate for Payer: United Healthcare HMO Rider |
$24.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.41
|
| Rate for Payer: Vantage Medical Group Senior |
$42.41
|
|
|
HC SOM ETHANOL, U
|
Facility
|
IP
|
$49.90
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900912919
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$44.91 |
| Rate for Payer: Adventist Health Commercial |
$9.98
|
| Rate for Payer: Cash Price |
$49.90
|
| Rate for Payer: Central Health Plan Commercial |
$39.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.96
|
| Rate for Payer: EPIC Health Plan Senior |
$19.96
|
| Rate for Payer: Galaxy Health WC |
$42.41
|
| Rate for Payer: Global Benefits Group Commercial |
$29.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.98
|
| Rate for Payer: Multiplan Commercial |
$37.42
|
| Rate for Payer: Networks By Design Commercial |
$32.44
|
| Rate for Payer: Prime Health Services Commercial |
$42.41
|
|
|
HC SOM ETHCHLORVINYL (PLACIDYL)
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$623.23 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.23
|
| 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 |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| 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 |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| 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 |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| 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 |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM ETHCHLORVINYL (PLACIDYL)
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910427
|
|
Hospital Revenue Code
|
301
|
| 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 ETHOSUXIMIDE (ZARONTIN)
|
Facility
|
OP
|
$37.58
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
900910338
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$165.25 |
| Rate for Payer: Adventist Health Commercial |
$7.52
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.25
|
| Rate for Payer: Blue Shield of California Commercial |
$23.68
|
| Rate for Payer: Blue Shield of California EPN |
$14.92
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Central Health Plan Commercial |
$30.06
|
| Rate for Payer: Cigna of CA HMO |
$24.05
|
| Rate for Payer: Cigna of CA PPO |
$27.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.96
|
| Rate for Payer: EPIC Health Plan Senior |
$17.97
|
| Rate for Payer: Galaxy Health WC |
$31.94
|
| Rate for Payer: Global Benefits Group Commercial |
$22.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.90
|
| Rate for Payer: Multiplan Commercial |
$28.18
|
| Rate for Payer: Networks By Design Commercial |
$24.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.34
|
| Rate for Payer: Prime Health Services Commercial |
$31.94
|
| Rate for Payer: Prime Health Services Medicare |
$17.32
|
| Rate for Payer: Riverside University Health System MISP |
$17.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.24
|
| Rate for Payer: United Healthcare All Other HMO |
$13.24
|
| Rate for Payer: United Healthcare HMO Rider |
$13.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.97
|
| Rate for Payer: Vantage Medical Group Senior |
$16.34
|
|
|
HC SOM ETHOSUXIMIDE (ZARONTIN)
|
Facility
|
IP
|
$37.58
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
900910338
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Adventist Health Commercial |
$7.52
|
| Rate for Payer: Cash Price |
$37.58
|
| Rate for Payer: Central Health Plan Commercial |
$30.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.03
|
| Rate for Payer: EPIC Health Plan Senior |
$15.03
|
| Rate for Payer: Galaxy Health WC |
$31.94
|
| Rate for Payer: Global Benefits Group Commercial |
$22.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.52
|
| Rate for Payer: Multiplan Commercial |
$28.18
|
| Rate for Payer: Networks By Design Commercial |
$24.43
|
| Rate for Payer: Prime Health Services Commercial |
$31.94
|
|
|
HC SOM EVEROLIMUS B
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913810
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$97.68 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.65
|
| Rate for Payer: EPIC Health Plan Senior |
$15.10
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.73
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.55
|
| Rate for Payer: Riverside University Health System MISP |
$15.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC SOM EVEROLIMUS B
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
900913810
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM FACTOR IX BETHESDA UNITS
|
Facility
|
IP
|
$130.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$117.40 |
| Rate for Payer: Adventist Health Commercial |
$26.09
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Central Health Plan Commercial |
$104.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.18
|
| Rate for Payer: EPIC Health Plan Senior |
$52.18
|
| Rate for Payer: Galaxy Health WC |
$110.87
|
| Rate for Payer: Global Benefits Group Commercial |
$78.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.09
|
| Rate for Payer: Multiplan Commercial |
$97.83
|
| Rate for Payer: Networks By Design Commercial |
$84.79
|
| Rate for Payer: Prime Health Services Commercial |
$110.87
|
|
|
HC SOM FACTOR IX BETHESDA UNITS
|
Facility
|
OP
|
$130.44
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
900915517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$130.19 |
| Rate for Payer: Adventist Health Commercial |
$26.09
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.19
|
| Rate for Payer: Blue Shield of California Commercial |
$82.18
|
| Rate for Payer: Blue Shield of California EPN |
$51.78
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Cash Price |
$130.44
|
| Rate for Payer: Central Health Plan Commercial |
$104.35
|
| Rate for Payer: Cigna of CA HMO |
$83.48
|
| Rate for Payer: Cigna of CA PPO |
$96.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.16
|
| Rate for Payer: Galaxy Health WC |
$110.87
|
| Rate for Payer: Global Benefits Group Commercial |
$78.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$97.83
|
| Rate for Payer: Networks By Design Commercial |
$84.79
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$110.87
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC SOM FACTOR IX INHIB PROF INTERP
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.16
|
| Rate for Payer: Blue Shield of California Commercial |
$47.25
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.54
|
| Rate for Payer: EPIC Health Plan Senior |
$17.03
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM FACTOR IX INHIB PROF INTERP
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900915516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
