|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.91
|
| Rate for Payer: Blue Shield of California Commercial |
$8.70
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.91
|
| Rate for Payer: Blue Shield of California Commercial |
$8.70
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.91
|
| Rate for Payer: Blue Shield of California Commercial |
$9.03
|
| Rate for Payer: Blue Shield of California EPN |
$5.97
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$8.64
|
| Rate for Payer: Cigna of CA PPO |
$9.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.91
|
| Rate for Payer: Blue Shield of California Commercial |
$9.03
|
| Rate for Payer: Blue Shield of California EPN |
$5.97
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$8.64
|
| Rate for Payer: Cigna of CA PPO |
$9.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.24
|
| Rate for Payer: Multiplan Commercial |
$10.80
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$79.69 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.50
|
| Rate for Payer: EPIC Health Plan Senior |
$37.50
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$1,642.68 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,642.68
|
| Rate for Payer: Blue Shield of California Commercial |
$62.72
|
| Rate for Payer: Blue Shield of California EPN |
$41.44
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cigna of CA HMO |
$60.00
|
| Rate for Payer: Cigna of CA PPO |
$69.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.44
|
| Rate for Payer: EPIC Health Plan Senior |
$173.66
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$248.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.66
|
| Rate for Payer: United Healthcare All Other HMO |
$140.66
|
| Rate for Payer: United Healthcare HMO Rider |
$140.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.56
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| 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 |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| 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 |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$240.72 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.72
|
| Rate for Payer: Blue Shield of California Commercial |
$57.53
|
| Rate for Payer: Blue Shield of California EPN |
$38.01
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.90
|
| Rate for Payer: EPIC Health Plan Senior |
$24.37
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.74
|
| Rate for Payer: United Healthcare All Other HMO |
$19.74
|
| Rate for Payer: United Healthcare HMO Rider |
$19.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.56
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.56
|
| Rate for Payer: Blue Shield of California Commercial |
$30.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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 |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| 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 |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$11.76 |
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.53
|
| Rate for Payer: EPIC Health Plan Senior |
$5.53
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$200.62 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.62
|
| Rate for Payer: Blue Shield of California Commercial |
$9.25
|
| Rate for Payer: Blue Shield of California EPN |
$6.11
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cigna of CA HMO |
$8.85
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.43
|
| Rate for Payer: EPIC Health Plan Senior |
$20.32
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$608.65 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.39
|
| 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 HMO/PPO |
$608.65
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Blue Shield of California EPN |
$66.30
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| 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: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| 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 COPPER LIVER TISSUE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM COPPER LIVER TISSUE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$122.89 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.89
|
| Rate for Payer: Blue Shield of California Commercial |
$43.48
|
| Rate for Payer: Blue Shield of California EPN |
$28.73
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Senior |
$12.41
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER SERUM
|
Facility
|
OP
|
$14.32
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$122.89 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.89
|
| Rate for Payer: Blue Shield of California Commercial |
$9.58
|
| Rate for Payer: Blue Shield of California EPN |
$6.33
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$9.16
|
| Rate for Payer: Cigna of CA PPO |
$10.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Senior |
$12.41
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$11.46
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
