|
HC SOM CORT FREE QUANTITATION
|
Facility
|
IP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.99
|
| Rate for Payer: EPIC Health Plan Senior |
$7.99
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| 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
|
|
|
HC SOM CORTISOL FREE RANDOM UR
|
Facility
|
OP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$175.04 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.04
|
| Rate for Payer: Blue Shield of California Commercial |
$14.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.61
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cigna of CA HMO |
$19.85
|
| Rate for Payer: Cigna of CA PPO |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.57
|
| Rate for Payer: EPIC Health Plan Senior |
$18.38
|
| Rate for Payer: Galaxy Health WC |
$26.36
|
| Rate for Payer: Global Benefits Group Commercial |
$18.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$24.81
|
| Rate for Payer: Networks By Design Commercial |
$20.16
|
| Rate for Payer: Prime Health Services Commercial |
$26.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE RANDOM UR
|
Facility
|
IP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.36 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.36
|
| Rate for Payer: Global Benefits Group Commercial |
$18.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$24.81
|
| Rate for Payer: Networks By Design Commercial |
$20.16
|
| Rate for Payer: Prime Health Services Commercial |
$26.36
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$34.51 |
| Rate for Payer: Adventist Health Commercial |
$8.12
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.24
|
| Rate for Payer: EPIC Health Plan Senior |
$16.24
|
| Rate for Payer: Galaxy Health WC |
$34.51
|
| Rate for Payer: Global Benefits Group Commercial |
$24.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.74
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Networks By Design Commercial |
$26.39
|
| Rate for Payer: Prime Health Services Commercial |
$34.51
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
OP
|
$40.60
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$175.04 |
| Rate for Payer: Adventist Health Commercial |
$8.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.04
|
| Rate for Payer: Blue Shield of California Commercial |
$18.72
|
| Rate for Payer: Blue Shield of California Commercial |
$28.30
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cigna of CA HMO |
$25.98
|
| Rate for Payer: Cigna of CA PPO |
$30.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.57
|
| Rate for Payer: EPIC Health Plan Senior |
$18.38
|
| Rate for Payer: Galaxy Health WC |
$34.51
|
| Rate for Payer: Global Benefits Group Commercial |
$24.36
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$32.48
|
| Rate for Payer: Networks By Design Commercial |
$26.39
|
| Rate for Payer: Prime Health Services Commercial |
$34.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE UR
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$175.04 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.04
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$17.43
|
| 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 |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.57
|
| Rate for Payer: EPIC Health Plan Senior |
$18.38
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| 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 |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE UR
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 CORTISOL FREE URINE
|
Facility
|
IP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.36 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.36
|
| Rate for Payer: Global Benefits Group Commercial |
$18.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$24.81
|
| Rate for Payer: Networks By Design Commercial |
$20.16
|
| Rate for Payer: Prime Health Services Commercial |
$26.36
|
|
|
HC SOM CORTISOL FREE URINE
|
Facility
|
OP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$175.04 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.04
|
| Rate for Payer: Blue Shield of California Commercial |
$14.30
|
| Rate for Payer: Blue Shield of California Commercial |
$21.61
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cigna of CA HMO |
$19.85
|
| Rate for Payer: Cigna of CA PPO |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.57
|
| Rate for Payer: EPIC Health Plan Senior |
$18.38
|
| Rate for Payer: Galaxy Health WC |
$26.36
|
| Rate for Payer: Global Benefits Group Commercial |
$18.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$24.81
|
| Rate for Payer: Networks By Design Commercial |
$20.16
|
| Rate for Payer: Prime Health Services Commercial |
$26.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM COUMADIN LEVEL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$178.38 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.38
|
| Rate for Payer: Blue Shield of California Commercial |
$50.25
|
| Rate for Payer: Blue Shield of California Commercial |
$75.97
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.50
|
| Rate for Payer: United Healthcare All Other HMO |
$54.50
|
| Rate for Payer: United Healthcare HMO Rider |
$54.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
|
|
HC SOM COUMADIN LEVEL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$92.65 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.52 |
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$130.29 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4.62
|
| Rate for Payer: Blue Shield of California Commercial |
$6.98
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.33
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$8.02
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$175.04 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.04
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$14.14 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.21
|
| Rate for Payer: Blue Shield of California Commercial |
$11.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.67
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$10.65
|
| Rate for Payer: Cigna of CA PPO |
$12.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.00
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO |
$9.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
OP
|
$17.85
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.21
|
| Rate for Payer: Blue Shield of California Commercial |
$12.44
|
| Rate for Payer: Blue Shield of California Commercial |
$8.23
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cigna of CA HMO |
$11.42
|
| Rate for Payer: Cigna of CA PPO |
$13.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Senior |
$13.95
|
| Rate for Payer: Galaxy Health WC |
$15.17
|
| Rate for Payer: Global Benefits Group Commercial |
$10.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$14.28
|
| Rate for Payer: Networks By Design Commercial |
$11.60
|
| Rate for Payer: Prime Health Services Commercial |
$15.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
IP
|
$17.85
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$15.17 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: EPIC Health Plan Senior |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$15.17
|
| Rate for Payer: Global Benefits Group Commercial |
$10.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.28
|
| Rate for Payer: Multiplan Commercial |
$14.28
|
| Rate for Payer: Networks By Design Commercial |
$11.60
|
| Rate for Payer: Prime Health Services Commercial |
$15.17
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$14.14 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.21
|
| Rate for Payer: Blue Shield of California Commercial |
$11.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.67
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$10.65
|
| Rate for Payer: Cigna of CA PPO |
$12.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.00
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO |
$9.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
IP
|
$17.86
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$15.18 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: EPIC Health Plan Senior |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$15.18
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$14.29
|
| Rate for Payer: Networks By Design Commercial |
$11.61
|
| Rate for Payer: Prime Health Services Commercial |
$15.18
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
OP
|
$17.86
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$133.21 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.21
|
| Rate for Payer: Blue Shield of California Commercial |
$12.45
|
| Rate for Payer: Blue Shield of California Commercial |
$8.23
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cigna of CA HMO |
$11.43
|
| Rate for Payer: Cigna of CA PPO |
$13.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Senior |
$13.95
|
| Rate for Payer: Galaxy Health WC |
$15.18
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$14.29
|
| Rate for Payer: Networks By Design Commercial |
$11.61
|
| Rate for Payer: Prime Health Services Commercial |
$15.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.68
|
| Rate for Payer: EPIC Health Plan Senior |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$14.19
|
| Rate for Payer: Global Benefits Group Commercial |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Networks By Design Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Commercial |
$14.19
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
OP
|
$16.69
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$88.53 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.53
|
| Rate for Payer: Blue Shield of California Commercial |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cigna of CA HMO |
$10.68
|
| Rate for Payer: Cigna of CA PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.33
|
| Rate for Payer: EPIC Health Plan Senior |
$15.55
|
| Rate for Payer: Galaxy Health WC |
$14.19
|
| Rate for Payer: Global Benefits Group Commercial |
$10.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$13.35
|
| Rate for Payer: Networks By Design Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Commercial |
$14.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
