|
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 |
$251.55 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$202.73
|
| 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 |
$251.55
|
| Rate for Payer: Blue Shield of California Commercial |
$39.65
|
| Rate for Payer: Blue Shield of California Commercial |
$59.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.21
|
| Rate for Payer: EPIC Health Plan Senior |
$26.81
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.12
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$54.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.74
|
| 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 C-2
|
Facility
|
OP
|
$49.63
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$123.90 |
| Rate for Payer: Cigna of CA PPO |
$36.73
|
| Rate for Payer: Adventist Health Commercial |
$9.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| 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 |
$123.90
|
| Rate for Payer: Blue Shield of California Commercial |
$22.88
|
| Rate for Payer: Blue Shield of California Commercial |
$34.59
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Cigna of CA HMO |
$31.76
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$42.19
|
| Rate for Payer: Global Benefits Group Commercial |
$29.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$31.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.91
|
| 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 |
$39.70
|
| Rate for Payer: Networks By Design Commercial |
$32.26
|
| Rate for Payer: Prime Health Services Commercial |
$42.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.78
|
| 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
|
$49.63
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: Adventist Health Commercial |
$9.93
|
| Rate for Payer: Cash Price |
$49.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.85
|
| Rate for Payer: EPIC Health Plan Senior |
$19.85
|
| Rate for Payer: Galaxy Health WC |
$42.19
|
| Rate for Payer: Global Benefits Group Commercial |
$29.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.91
|
| Rate for Payer: Multiplan Commercial |
$39.70
|
| Rate for Payer: Networks By Design Commercial |
$32.26
|
| Rate for Payer: Prime Health Services Commercial |
$42.19
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
IP
|
$45.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$38.96 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.33
|
| Rate for Payer: EPIC Health Plan Senior |
$18.33
|
| Rate for Payer: Galaxy Health WC |
$38.96
|
| Rate for Payer: Global Benefits Group Commercial |
$27.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$36.66
|
| Rate for Payer: Networks By Design Commercial |
$29.79
|
| Rate for Payer: Prime Health Services Commercial |
$38.96
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
OP
|
$45.83
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$123.90 |
| Rate for Payer: Adventist Health Commercial |
$9.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.83
|
| 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 |
$123.90
|
| Rate for Payer: Blue Shield of California Commercial |
$21.13
|
| Rate for Payer: Blue Shield of California Commercial |
$31.94
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Cash Price |
$45.83
|
| Rate for Payer: Cigna of CA HMO |
$29.33
|
| Rate for Payer: Cigna of CA PPO |
$33.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.20
|
| Rate for Payer: Galaxy Health WC |
$38.96
|
| Rate for Payer: Global Benefits Group Commercial |
$27.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$29.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| 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 |
$36.66
|
| Rate for Payer: Networks By Design Commercial |
$29.79
|
| Rate for Payer: Prime Health Services Commercial |
$38.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.50
|
| 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 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: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.53
|
| Rate for Payer: EPIC Health Plan Senior |
$5.53
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.16
|
| 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 |
$209.65 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.94
|
| 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 |
$209.65
|
| Rate for Payer: Blue Shield of California Commercial |
$6.38
|
| Rate for Payer: Blue Shield of California Commercial |
$9.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.53
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| 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 |
$636.03 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| 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 |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$104.55
|
| Rate for Payer: Blue Shield of California Commercial |
$69.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 CONTROLLED SUB MON 1
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$1,700.33 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$981.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,700.33
|
| Rate for Payer: Blue Shield of California Commercial |
$29.85
|
| Rate for Payer: Blue Shield of California Commercial |
$45.13
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$47.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.92
|
| Rate for Payer: EPIC Health Plan Senior |
$218.61
|
| Rate for Payer: Galaxy Health WC |
$55.04
|
| Rate for Payer: Global Benefits Group Commercial |
$38.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$325.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.31
|
| Rate for Payer: Multiplan Commercial |
$51.80
|
| Rate for Payer: Networks By Design Commercial |
$42.09
|
| Rate for Payer: Prime Health Services Commercial |
$55.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.98
|
| Rate for Payer: United Healthcare All Other HMO |
$160.98
|
| Rate for Payer: United Healthcare HMO Rider |
$160.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.61
|
| Rate for Payer: Vantage Medical Group Senior |
$198.74
|
|
|
HC SOM CONTROLLED SUB MON 1
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$55.04 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.90
|
| Rate for Payer: EPIC Health Plan Senior |
$25.90
|
| Rate for Payer: Galaxy Health WC |
$55.04
|
| Rate for Payer: Global Benefits Group Commercial |
$38.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.54
|
| Rate for Payer: Multiplan Commercial |
$51.80
|
| Rate for Payer: Networks By Design Commercial |
$42.09
|
| Rate for Payer: Prime Health Services Commercial |
$55.04
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$636.03 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| 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 |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$14.11
|
| Rate for Payer: Blue Shield of California Commercial |
$9.34
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$12.96
|
| Rate for Payer: Cigna of CA PPO |
$14.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.86
|
| 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 |
$16.20
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.15
|
| 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 CONTROLLED SUB MON 3
|
Facility
|
OP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$201.38 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$201.38
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cigna of CA HMO |
$15.37
|
| Rate for Payer: Cigna of CA PPO |
$17.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.41
|
| Rate for Payer: Global Benefits Group Commercial |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$19.21
|
| Rate for Payer: Networks By Design Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Commercial |
$20.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.01
|
| Rate for Payer: United Healthcare All Other HMO |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.41
|
| Rate for Payer: Vantage Medical Group Senior |
$20.41
|
|
|
HC SOM CONTROLLED SUB MON 3
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.41 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.41
|
| Rate for Payer: Global Benefits Group Commercial |
$14.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.21
|
| Rate for Payer: Networks By Design Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Commercial |
$20.41
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
OP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$184.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4.43
|
| Rate for Payer: Blue Shield of California Commercial |
$6.71
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cigna of CA HMO |
$6.16
|
| Rate for Payer: Cigna of CA PPO |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.85
|
| Rate for Payer: EPIC Health Plan Senior |
$3.85
|
| Rate for Payer: Galaxy Health WC |
$8.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$7.70
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO |
$4.81
|
| Rate for Payer: United Healthcare HMO Rider |
$4.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.18
|
| Rate for Payer: Vantage Medical Group Senior |
$8.18
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
IP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.18 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.85
|
| Rate for Payer: EPIC Health Plan Senior |
$3.85
|
| Rate for Payer: Galaxy Health WC |
$8.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$7.70
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
|
|
HC SOM COPPER LIVER TISSUE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$128.42 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.17
|
| 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 |
$128.42
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.65
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| 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 |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| 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 LIVER TISSUE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC SOM COPPER SERUM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM COPPER SERUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$128.42 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.17
|
| 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 |
$128.42
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.65
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| 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 |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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
|
|
|
HC SOM COPPER URINE
|
Facility
|
IP
|
$39.97
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Adventist Health Commercial |
$7.99
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.99
|
| Rate for Payer: EPIC Health Plan Senior |
$15.99
|
| Rate for Payer: Galaxy Health WC |
$33.97
|
| Rate for Payer: Global Benefits Group Commercial |
$23.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| Rate for Payer: Multiplan Commercial |
$31.98
|
| Rate for Payer: Networks By Design Commercial |
$25.98
|
| Rate for Payer: Prime Health Services Commercial |
$33.97
|
|
|
HC SOM COPPER URINE
|
Facility
|
OP
|
$39.97
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$128.42 |
| Rate for Payer: Adventist Health Commercial |
$7.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.17
|
| 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 |
$128.42
|
| Rate for Payer: Blue Shield of California Commercial |
$18.43
|
| Rate for Payer: Blue Shield of California Commercial |
$27.86
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$29.58
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.65
|
| Rate for Payer: Galaxy Health WC |
$33.97
|
| Rate for Payer: Global Benefits Group Commercial |
$23.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$25.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| 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 |
$31.98
|
| Rate for Payer: Networks By Design Commercial |
$25.98
|
| Rate for Payer: Prime Health Services Commercial |
$33.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.98
|
| 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 CORT FREE QUANTITATION
|
Facility
|
OP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$185.61 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.61
|
| Rate for Payer: Blue Shield of California Commercial |
$13.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9.21
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cigna of CA HMO |
$12.78
|
| Rate for Payer: Cigna of CA PPO |
$14.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$15.98
|
| Rate for Payer: Networks By Design Commercial |
$12.98
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
