|
HC SOM VEDOLIZUMAB QN
|
Facility
|
OP
|
$172.02
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
900915324
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$227.89 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.06
|
| Rate for Payer: Blue Shield of California Commercial |
$119.90
|
| Rate for Payer: Blue Shield of California Commercial |
$79.30
|
| Rate for Payer: Cash Price |
$172.02
|
| Rate for Payer: Cash Price |
$172.02
|
| Rate for Payer: Cigna of CA HMO |
$110.09
|
| Rate for Payer: Cigna of CA PPO |
$127.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.64
|
| Rate for Payer: EPIC Health Plan Senior |
$42.43
|
| Rate for Payer: Galaxy Health WC |
$146.22
|
| Rate for Payer: Global Benefits Group Commercial |
$103.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$137.62
|
| Rate for Payer: Networks By Design Commercial |
$111.81
|
| Rate for Payer: Prime Health Services Commercial |
$146.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
|
|
HC SOM VITAMIN A
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$119.66 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.66
|
| 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 |
$17.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.16
|
| Rate for Payer: EPIC Health Plan Senior |
$12.77
|
| 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 |
$19.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.56
|
| 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 |
$9.40
|
| Rate for Payer: United Healthcare All Other HMO |
$9.40
|
| Rate for Payer: United Healthcare HMO Rider |
$9.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Vantage Medical Group Senior |
$11.61
|
|
|
HC SOM VITAMIN A
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
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 VITAMIN B1 (THIAMINE)
|
Facility
|
IP
|
$16.50
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$14.03 |
| Rate for Payer: Galaxy Health WC |
$14.03
|
| Rate for Payer: EPIC Health Plan Senior |
$6.60
|
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$10.72
|
| Rate for Payer: Prime Health Services Commercial |
$14.03
|
|
|
HC SOM VITAMIN B1 (THIAMINE)
|
Facility
|
OP
|
$16.50
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$186.16 |
| Rate for Payer: Adventist Health Commercial |
$3.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna of CA HMO |
$10.56
|
| Rate for Payer: Cigna of CA PPO |
$12.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.03
|
| Rate for Payer: EPIC Health Plan Senior |
$23.35
|
| Rate for Payer: Galaxy Health WC |
$14.03
|
| Rate for Payer: Global Benefits Group Commercial |
$9.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.45
|
| Rate for Payer: Multiplan Commercial |
$13.20
|
| Rate for Payer: Networks By Design Commercial |
$10.72
|
| Rate for Payer: Prime Health Services Commercial |
$14.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.20
|
| Rate for Payer: United Healthcare All Other HMO |
$17.20
|
| Rate for Payer: United Healthcare HMO Rider |
$17.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: Vantage Medical Group Senior |
$21.23
|
|
|
HC SOM VITAMIN B6
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$246.13 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.48
|
| Rate for Payer: Blue Shield of California Commercial |
$8.25
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.37
|
| Rate for Payer: EPIC Health Plan Senior |
$30.91
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$46.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.65
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.76
|
| Rate for Payer: United Healthcare All Other HMO |
$22.76
|
| Rate for Payer: United Healthcare HMO Rider |
$22.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$28.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: Vantage Medical Group Senior |
$28.10
|
|
|
HC SOM VITAMIN B6
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: EPIC Health Plan Senior |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.53
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
|
IP
|
$17.22
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$14.64 |
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.89
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$14.64
|
| Rate for Payer: Global Benefits Group Commercial |
$10.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$14.64
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
|
OP
|
$17.22
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$305.54 |
| Rate for Payer: Cigna of CA PPO |
$12.74
|
| Rate for Payer: Adventist Health Commercial |
$3.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.54
|
| Rate for Payer: Blue Shield of California Commercial |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7.94
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cigna of CA HMO |
$11.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.84
|
| Rate for Payer: EPIC Health Plan Senior |
$32.56
|
| Rate for Payer: Galaxy Health WC |
$14.64
|
| Rate for Payer: Global Benefits Group Commercial |
$10.33
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$13.78
|
| Rate for Payer: Networks By Design Commercial |
$11.19
|
| Rate for Payer: Prime Health Services Commercial |
$14.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC SOM VITAMIN E
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
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 VITAMIN E
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$146.27 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.27
|
| 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 |
$21.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.40
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| 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 |
$23.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.00
|
| 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 |
$11.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11.48
|
| Rate for Payer: United Healthcare HMO Rider |
$11.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14.18
|
|
|
HC SOM VITAMIN K
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$136.89 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.89
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$24.39
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.64
|
| Rate for Payer: EPIC Health Plan Senior |
$15.09
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.72
|
|
|
HC SOM VITAMIN K
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$29.75 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
|
IP
|
$42.26
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$35.92 |
| Rate for Payer: Adventist Health Commercial |
$8.45
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Senior |
$16.90
|
| Rate for Payer: Galaxy Health WC |
$35.92
|
| Rate for Payer: Global Benefits Group Commercial |
$25.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$33.81
|
| Rate for Payer: Networks By Design Commercial |
$27.47
|
| Rate for Payer: Prime Health Services Commercial |
$35.92
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
|
OP
|
$42.26
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$107.01 |
| Rate for Payer: Adventist Health Commercial |
$8.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.01
|
| Rate for Payer: Blue Shield of California Commercial |
$19.48
|
| Rate for Payer: Blue Shield of California Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Cigna of CA HMO |
$27.05
|
| Rate for Payer: Cigna of CA PPO |
$31.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Senior |
$16.90
|
| Rate for Payer: Galaxy Health WC |
$35.92
|
| Rate for Payer: Global Benefits Group Commercial |
$25.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.58
|
| Rate for Payer: Multiplan Commercial |
$33.81
|
| Rate for Payer: Networks By Design Commercial |
$27.47
|
| Rate for Payer: Prime Health Services Commercial |
$35.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.13
|
| Rate for Payer: United Healthcare All Other HMO |
$21.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.92
|
| Rate for Payer: Vantage Medical Group Senior |
$35.92
|
|
|
HC SOM VOLATILES URINE
|
Facility
|
IP
|
$42.26
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$35.92 |
| Rate for Payer: Adventist Health Commercial |
$8.45
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Senior |
$16.90
|
| Rate for Payer: Galaxy Health WC |
$35.92
|
| Rate for Payer: Global Benefits Group Commercial |
$25.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.14
|
| Rate for Payer: Multiplan Commercial |
$33.81
|
| Rate for Payer: Networks By Design Commercial |
$27.47
|
| Rate for Payer: Prime Health Services Commercial |
$35.92
|
|
|
HC SOM VOLATILES URINE
|
Facility
|
OP
|
$42.26
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$107.01 |
| Rate for Payer: Adventist Health Commercial |
$8.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.01
|
| Rate for Payer: Blue Shield of California Commercial |
$19.48
|
| Rate for Payer: Blue Shield of California Commercial |
$29.46
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Cigna of CA HMO |
$27.05
|
| Rate for Payer: Cigna of CA PPO |
$31.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.90
|
| Rate for Payer: EPIC Health Plan Senior |
$16.90
|
| Rate for Payer: Galaxy Health WC |
$35.92
|
| Rate for Payer: Global Benefits Group Commercial |
$25.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.58
|
| Rate for Payer: Multiplan Commercial |
$33.81
|
| Rate for Payer: Networks By Design Commercial |
$27.47
|
| Rate for Payer: Prime Health Services Commercial |
$35.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.13
|
| Rate for Payer: United Healthcare All Other HMO |
$21.13
|
| Rate for Payer: United Healthcare HMO Rider |
$21.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.92
|
| Rate for Payer: Vantage Medical Group Senior |
$35.92
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
|
IP
|
$18.56
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$15.78 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.42
|
| Rate for Payer: EPIC Health Plan Senior |
$7.42
|
| Rate for Payer: Galaxy Health WC |
$15.78
|
| Rate for Payer: Global Benefits Group Commercial |
$11.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: Networks By Design Commercial |
$12.06
|
| Rate for Payer: Prime Health Services Commercial |
$15.78
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
|
OP
|
$18.56
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$236.82 |
| Rate for Payer: Adventist Health Commercial |
$3.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.82
|
| Rate for Payer: Blue Shield of California Commercial |
$12.94
|
| Rate for Payer: Blue Shield of California Commercial |
$8.56
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cigna of CA HMO |
$11.88
|
| Rate for Payer: Cigna of CA PPO |
$13.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.85
|
| Rate for Payer: EPIC Health Plan Senior |
$25.23
|
| Rate for Payer: Galaxy Health WC |
$15.78
|
| Rate for Payer: Global Benefits Group Commercial |
$11.14
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$14.85
|
| Rate for Payer: Networks By Design Commercial |
$12.06
|
| Rate for Payer: Prime Health Services Commercial |
$15.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$236.12 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.12
|
| Rate for Payer: Blue Shield of California Commercial |
$25.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.34
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.92
|
| Rate for Payer: EPIC Health Plan Senior |
$33.95
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.35
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.99
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
IP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$43.44 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.44
|
| Rate for Payer: EPIC Health Plan Senior |
$20.44
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.26
|
| Rate for Payer: Multiplan Commercial |
$40.88
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$236.82 |
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.82
|
| Rate for Payer: Blue Shield of California Commercial |
$23.56
|
| Rate for Payer: Blue Shield of California Commercial |
$35.62
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cigna of CA HMO |
$32.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.85
|
| Rate for Payer: EPIC Health Plan Senior |
$25.23
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$40.88
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$160.18 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.16
|
| Rate for Payer: Blue Shield of California Commercial |
$12.50
|
| Rate for Payer: Blue Shield of California Commercial |
$18.90
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.73
|
| Rate for Payer: EPIC Health Plan Senior |
$29.82
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$21.69
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.51
|
| Rate for Payer: Multiplan Commercial |
$21.69
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
