|
HC SOM MCLON PROT ELEC. U
|
Facility
|
IP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.01
|
| Rate for Payer: EPIC Health Plan Senior |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: Prime Health Services Commercial |
$14.90
|
|
|
HC SOM MCLON PROT ELEC. U
|
Facility
|
OP
|
$17.53
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900912767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$176.69 |
| Rate for Payer: Adventist Health Commercial |
$3.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Cash Price |
$17.53
|
| Rate for Payer: Central Health Plan Commercial |
$14.02
|
| Rate for Payer: Cigna of CA HMO |
$11.22
|
| Rate for Payer: Cigna of CA PPO |
$12.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.42
|
| Rate for Payer: EPIC Health Plan Senior |
$19.61
|
| Rate for Payer: Galaxy Health WC |
$14.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$13.15
|
| Rate for Payer: Networks By Design Commercial |
$11.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.83
|
| Rate for Payer: Prime Health Services Commercial |
$14.90
|
| Rate for Payer: Prime Health Services Medicare |
$18.90
|
| Rate for Payer: Riverside University Health System MISP |
$19.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$2.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1.44
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
|
|
HC SOM MCLON T. PROT U
|
Facility
|
OP
|
$3.61
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
900912765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$37.18 |
| Rate for Payer: Adventist Health Commercial |
$0.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2.27
|
| Rate for Payer: Blue Shield of California EPN |
$1.43
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Cash Price |
$3.61
|
| Rate for Payer: Central Health Plan Commercial |
$2.89
|
| Rate for Payer: Cigna of CA HMO |
$2.31
|
| Rate for Payer: Cigna of CA PPO |
$2.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$3.07
|
| Rate for Payer: Global Benefits Group Commercial |
$2.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$2.71
|
| Rate for Payer: Networks By Design Commercial |
$2.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.07
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
IP
|
$24.16
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Central Health Plan Commercial |
$19.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.66
|
| Rate for Payer: EPIC Health Plan Senior |
$9.66
|
| Rate for Payer: Galaxy Health WC |
$20.54
|
| Rate for Payer: Global Benefits Group Commercial |
$14.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
| Rate for Payer: Networks By Design Commercial |
$15.70
|
| Rate for Payer: Prime Health Services Commercial |
$20.54
|
|
|
HC SOM MEASLES AB CSF IGG
|
Facility
|
OP
|
$24.16
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900911355
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| 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 |
$15.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.59
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Central Health Plan Commercial |
$19.33
|
| Rate for Payer: Cigna of CA HMO |
$15.46
|
| Rate for Payer: Cigna of CA PPO |
$17.88
|
| 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 |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$20.54
|
| Rate for Payer: Global Benefits Group Commercial |
$14.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.74
|
| 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 |
$15.34
|
| 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 |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$18.12
|
| Rate for Payer: Networks By Design Commercial |
$15.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$20.54
|
| 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 |
$14.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: 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 MEASLES AB IGM CSF
|
Facility
|
IP
|
$24.15
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$21.73 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| Rate for Payer: Cash Price |
$24.15
|
| Rate for Payer: Central Health Plan Commercial |
$19.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.66
|
| Rate for Payer: EPIC Health Plan Senior |
$9.66
|
| Rate for Payer: Galaxy Health WC |
$20.53
|
| Rate for Payer: Global Benefits Group Commercial |
$14.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.83
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
| Rate for Payer: Networks By Design Commercial |
$15.70
|
| Rate for Payer: Prime Health Services Commercial |
$20.53
|
|
|
HC SOM MEASLES AB IGM CSF
|
Facility
|
OP
|
$24.15
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900912655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Adventist Health Commercial |
$4.83
|
| 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 |
$15.21
|
| Rate for Payer: Blue Shield of California EPN |
$9.59
|
| Rate for Payer: Cash Price |
$24.15
|
| Rate for Payer: Cash Price |
$24.15
|
| Rate for Payer: Central Health Plan Commercial |
$19.32
|
| Rate for Payer: Cigna of CA HMO |
$15.46
|
| Rate for Payer: Cigna of CA PPO |
$17.87
|
| 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 |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$20.53
|
| Rate for Payer: Global Benefits Group Commercial |
$14.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.73
|
| 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 |
$15.34
|
| 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 |
$4.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$18.11
|
| Rate for Payer: Networks By Design Commercial |
$15.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$20.53
|
| 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 |
$14.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.49
|
| 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 MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$98.89
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Central Health Plan Commercial |
$79.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.56
|
| Rate for Payer: EPIC Health Plan Senior |
$39.56
|
| Rate for Payer: Galaxy Health WC |
$84.06
|
| Rate for Payer: Global Benefits Group Commercial |
$59.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.78
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
| Rate for Payer: Networks By Design Commercial |
$64.28
|
| Rate for Payer: Prime Health Services Commercial |
$84.06
|
|
|
HC SOM MECONIUM AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$98.89
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
900912830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$802.17 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$114.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$577.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$802.17
|
| Rate for Payer: Blue Shield of California Commercial |
$62.30
|
| Rate for Payer: Blue Shield of California EPN |
$39.26
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Central Health Plan Commercial |
$79.11
|
| Rate for Payer: Cigna of CA HMO |
$63.29
|
| Rate for Payer: Cigna of CA PPO |
$73.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$171.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.81
|
| Rate for Payer: EPIC Health Plan Senior |
$125.87
|
| Rate for Payer: Galaxy Health WC |
$84.06
|
| Rate for Payer: Global Benefits Group Commercial |
$59.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$187.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$114.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.34
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
| Rate for Payer: Networks By Design Commercial |
$64.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$114.43
|
| Rate for Payer: Prime Health Services Commercial |
$84.06
|
| Rate for Payer: Prime Health Services Medicare |
$121.30
|
| Rate for Payer: Riverside University Health System MISP |
$125.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.69
|
| Rate for Payer: United Healthcare All Other HMO |
$92.69
|
| Rate for Payer: United Healthcare HMO Rider |
$92.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$114.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$171.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.87
|
| Rate for Payer: Vantage Medical Group Senior |
$114.43
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
IP
|
$86.41
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$77.77 |
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Central Health Plan Commercial |
$69.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Senior |
$34.56
|
| Rate for Payer: Galaxy Health WC |
$73.45
|
| Rate for Payer: Global Benefits Group Commercial |
$51.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$64.81
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Prime Health Services Commercial |
$73.45
|
|
|
HC SOM MECONIUM COCAINE CONFIRM
|
Facility
|
OP
|
$86.41
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
900912832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$147.07 |
| Rate for Payer: Adventist Health Commercial |
$17.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.07
|
| Rate for Payer: Blue Shield of California Commercial |
$54.44
|
| Rate for Payer: Blue Shield of California EPN |
$34.30
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Cash Price |
$86.41
|
| Rate for Payer: Central Health Plan Commercial |
$69.13
|
| Rate for Payer: Cigna of CA HMO |
$55.30
|
| Rate for Payer: Cigna of CA PPO |
$63.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.56
|
| Rate for Payer: EPIC Health Plan Senior |
$34.56
|
| Rate for Payer: Galaxy Health WC |
$73.45
|
| Rate for Payer: Global Benefits Group Commercial |
$51.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.49
|
| Rate for Payer: Multiplan Commercial |
$64.81
|
| Rate for Payer: Networks By Design Commercial |
$56.17
|
| Rate for Payer: Prime Health Services Commercial |
$73.45
|
| Rate for Payer: Riverside University Health System MISP |
$34.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Other HMO |
$43.20
|
| Rate for Payer: United Healthcare HMO Rider |
$43.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.45
|
| Rate for Payer: Vantage Medical Group Senior |
$73.45
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
IP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Central Health Plan Commercial |
$18.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: EPIC Health Plan Senior |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
|
|
HC SOM MECONIUM METHAMPHETAMINE CONF
|
Facility
|
OP
|
$23.42
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
900912831
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$150.82 |
| Rate for Payer: Adventist Health Commercial |
$4.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.82
|
| Rate for Payer: Blue Shield of California Commercial |
$14.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.30
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Cash Price |
$23.42
|
| Rate for Payer: Central Health Plan Commercial |
$18.74
|
| Rate for Payer: Cigna of CA HMO |
$14.99
|
| Rate for Payer: Cigna of CA PPO |
$17.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.37
|
| Rate for Payer: EPIC Health Plan Senior |
$9.37
|
| Rate for Payer: Galaxy Health WC |
$19.91
|
| Rate for Payer: Global Benefits Group Commercial |
$14.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.39
|
| Rate for Payer: Multiplan Commercial |
$17.57
|
| Rate for Payer: Networks By Design Commercial |
$15.22
|
| Rate for Payer: Prime Health Services Commercial |
$19.91
|
| Rate for Payer: Riverside University Health System MISP |
$9.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.71
|
| Rate for Payer: United Healthcare All Other HMO |
$11.71
|
| Rate for Payer: United Healthcare HMO Rider |
$11.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.91
|
| Rate for Payer: Vantage Medical Group Senior |
$19.91
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
OP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$188.75 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.80
|
| 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 |
$30.91
|
| Rate for Payer: Blue Shield of California EPN |
$19.48
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Central Health Plan Commercial |
$39.26
|
| Rate for Payer: Cigna of CA HMO |
$31.40
|
| Rate for Payer: Cigna of CA PPO |
$36.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: EPIC Health Plan Senior |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.35
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
| Rate for Payer: Riverside University Health System MISP |
$19.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.54
|
| Rate for Payer: United Healthcare All Other HMO |
$24.54
|
| Rate for Payer: United Healthcare HMO Rider |
$24.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.71
|
| Rate for Payer: Vantage Medical Group Senior |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM
|
Facility
|
IP
|
$49.07
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900912833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Adventist Health Commercial |
$9.81
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Central Health Plan Commercial |
$39.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.63
|
| Rate for Payer: EPIC Health Plan Senior |
$19.63
|
| Rate for Payer: Galaxy Health WC |
$41.71
|
| Rate for Payer: Global Benefits Group Commercial |
$29.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$31.90
|
| Rate for Payer: Prime Health Services Commercial |
$41.71
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
|
IP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$36.84 |
| Rate for Payer: Adventist Health Commercial |
$8.19
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Central Health Plan Commercial |
$32.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.37
|
| Rate for Payer: EPIC Health Plan Senior |
$16.37
|
| Rate for Payer: Galaxy Health WC |
$34.79
|
| Rate for Payer: Global Benefits Group Commercial |
$24.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$26.60
|
| Rate for Payer: Prime Health Services Commercial |
$34.79
|
|
|
HC SOM MECONIUM OPIATE CONFIRM OXYCODONE
|
Facility
|
OP
|
$40.93
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
900915377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$188.75 |
| Rate for Payer: Adventist Health Commercial |
$8.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.70
|
| 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 |
$25.79
|
| Rate for Payer: Blue Shield of California EPN |
$16.25
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Central Health Plan Commercial |
$32.74
|
| Rate for Payer: Cigna of CA HMO |
$26.20
|
| Rate for Payer: Cigna of CA PPO |
$30.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.37
|
| Rate for Payer: EPIC Health Plan Senior |
$16.37
|
| Rate for Payer: Galaxy Health WC |
$34.79
|
| Rate for Payer: Global Benefits Group Commercial |
$24.56
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.65
|
| Rate for Payer: Multiplan Commercial |
$30.70
|
| Rate for Payer: Networks By Design Commercial |
$26.60
|
| Rate for Payer: Prime Health Services Commercial |
$34.79
|
| Rate for Payer: Riverside University Health System MISP |
$16.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.56
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.46
|
| Rate for Payer: United Healthcare All Other HMO |
$20.46
|
| Rate for Payer: United Healthcare HMO Rider |
$20.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.79
|
| Rate for Payer: Vantage Medical Group Senior |
$34.79
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
IP
|
$98.89
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Central Health Plan Commercial |
$79.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.56
|
| Rate for Payer: EPIC Health Plan Senior |
$39.56
|
| Rate for Payer: Galaxy Health WC |
$84.06
|
| Rate for Payer: Global Benefits Group Commercial |
$59.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.78
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
| Rate for Payer: Networks By Design Commercial |
$64.28
|
| Rate for Payer: Prime Health Services Commercial |
$84.06
|
|
|
HC SOM MECONIUM PCP CONFIRM
|
Facility
|
OP
|
$98.89
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
900912835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Adventist Health Commercial |
$19.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.53
|
| Rate for Payer: Blue Shield of California Commercial |
$62.30
|
| Rate for Payer: Blue Shield of California EPN |
$39.26
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Cash Price |
$98.89
|
| Rate for Payer: Central Health Plan Commercial |
$79.11
|
| Rate for Payer: Cigna of CA HMO |
$63.29
|
| Rate for Payer: Cigna of CA PPO |
$73.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$69.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.56
|
| Rate for Payer: EPIC Health Plan Senior |
$39.56
|
| Rate for Payer: Galaxy Health WC |
$84.06
|
| Rate for Payer: Global Benefits Group Commercial |
$59.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$89.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$69.22
|
| Rate for Payer: Multiplan Commercial |
$74.17
|
| Rate for Payer: Networks By Design Commercial |
$64.28
|
| Rate for Payer: Prime Health Services Commercial |
$84.06
|
| Rate for Payer: Riverside University Health System MISP |
$39.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.27
|
| Rate for Payer: United Healthcare All Other HMO |
$30.27
|
| Rate for Payer: United Healthcare HMO Rider |
$30.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$84.06
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
IP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$68.49 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
|
|
HC SOM MECONIUM THC LAB REF CONFIRM
|
Facility
|
OP
|
$76.10
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
900912834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$229.80 |
| Rate for Payer: Adventist Health Commercial |
$15.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$165.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.80
|
| Rate for Payer: Blue Shield of California Commercial |
$47.94
|
| Rate for Payer: Blue Shield of California EPN |
$30.21
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Cash Price |
$76.10
|
| Rate for Payer: Central Health Plan Commercial |
$60.88
|
| Rate for Payer: Cigna of CA HMO |
$48.70
|
| Rate for Payer: Cigna of CA PPO |
$56.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Senior |
$30.44
|
| Rate for Payer: Galaxy Health WC |
$64.69
|
| Rate for Payer: Global Benefits Group Commercial |
$45.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.27
|
| Rate for Payer: Multiplan Commercial |
$57.08
|
| Rate for Payer: Networks By Design Commercial |
$49.47
|
| Rate for Payer: Prime Health Services Commercial |
$64.69
|
| Rate for Payer: Riverside University Health System MISP |
$30.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.69
|
| Rate for Payer: Vantage Medical Group Senior |
$64.69
|
|
|
HC SOM MENMS 81405
|
Facility
|
OP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$111.27 |
| Max. Negotiated Rate |
$2,383.56 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$301.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,714.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,383.56
|
| Rate for Payer: Blue Shield of California Commercial |
$350.50
|
| Rate for Payer: Blue Shield of California EPN |
$220.87
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Central Health Plan Commercial |
$445.08
|
| Rate for Payer: Cigna of CA HMO |
$356.06
|
| Rate for Payer: Cigna of CA PPO |
$411.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$331.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$301.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$389.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.23
|
| Rate for Payer: EPIC Health Plan Senior |
$331.49
|
| Rate for Payer: Galaxy Health WC |
$472.90
|
| Rate for Payer: Global Benefits Group Commercial |
$333.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$500.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$518.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$301.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$353.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$572.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
| Rate for Payer: Networks By Design Commercial |
$361.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$301.35
|
| Rate for Payer: Prime Health Services Commercial |
$472.90
|
| Rate for Payer: Prime Health Services Medicare |
$319.43
|
| Rate for Payer: Riverside University Health System MISP |
$331.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$301.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.49
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOM MENMS 81405
|
Facility
|
IP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$111.27 |
| Max. Negotiated Rate |
$500.71 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Central Health Plan Commercial |
$445.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$389.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.54
|
| Rate for Payer: EPIC Health Plan Senior |
$222.54
|
| Rate for Payer: Galaxy Health WC |
$472.90
|
| Rate for Payer: Global Benefits Group Commercial |
$333.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$500.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$353.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$328.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.27
|
| Rate for Payer: Multiplan Commercial |
$417.26
|
| Rate for Payer: Networks By Design Commercial |
$361.63
|
| Rate for Payer: Prime Health Services Commercial |
$472.90
|
|
|
HC SOM MEPERIDINE
|
Facility
|
IP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$88.45 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Central Health Plan Commercial |
$78.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Senior |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.54
|
| Rate for Payer: Global Benefits Group Commercial |
$58.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.66
|
| Rate for Payer: Multiplan Commercial |
$73.71
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.54
|
|
