|
HC SOM BRUCELLA AB CONFIRMATION
|
Facility
|
OP
|
$116.41
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912841
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$104.77 |
| Rate for Payer: Adventist Health Commercial |
$23.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$70.66
|
| Rate for Payer: Blue Shield of California EPN |
$46.21
|
| Rate for Payer: Cash Price |
$116.41
|
| Rate for Payer: Cash Price |
$116.41
|
| Rate for Payer: Central Health Plan Commercial |
$93.13
|
| Rate for Payer: Cigna of CA HMO |
$74.50
|
| Rate for Payer: Cigna of CA PPO |
$86.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.93
|
| Rate for Payer: Galaxy Health WC |
$98.95
|
| Rate for Payer: Global Benefits Group Commercial |
$69.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: InnovAge PACE Commercial |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$87.31
|
| Rate for Payer: Networks By Design Commercial |
$75.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.93
|
| Rate for Payer: Prime Health Services Commercial |
$98.95
|
| Rate for Payer: Prime Health Services Medicare |
$9.47
|
| Rate for Payer: Riverside University Health System MISP |
$9.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO |
$7.24
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB IGG
|
Facility
|
IP
|
$20.74
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900911628
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$18.67 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Central Health Plan Commercial |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.30
|
| Rate for Payer: Galaxy Health WC |
$17.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$15.55
|
| Rate for Payer: Networks By Design Commercial |
$13.48
|
| Rate for Payer: Prime Health Services Commercial |
$17.63
|
|
|
HC SOM BRUCELLA AB IGG
|
Facility
|
OP
|
$20.74
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900911628
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$58.67 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$12.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.23
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Central Health Plan Commercial |
$16.59
|
| Rate for Payer: Cigna of CA HMO |
$13.27
|
| Rate for Payer: Cigna of CA PPO |
$15.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.93
|
| Rate for Payer: Galaxy Health WC |
$17.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: InnovAge PACE Commercial |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$15.55
|
| Rate for Payer: Networks By Design Commercial |
$13.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.93
|
| Rate for Payer: Prime Health Services Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Medicare |
$9.47
|
| Rate for Payer: Riverside University Health System MISP |
$9.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO |
$7.24
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM BRUCELLA AB IGM
|
Facility
|
IP
|
$20.74
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$18.67 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Central Health Plan Commercial |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.30
|
| Rate for Payer: EPIC Health Plan Senior |
$8.30
|
| Rate for Payer: Galaxy Health WC |
$17.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Multiplan Commercial |
$15.55
|
| Rate for Payer: Networks By Design Commercial |
$13.48
|
| Rate for Payer: Prime Health Services Commercial |
$17.63
|
|
|
HC SOM BRUCELLA AB IGM
|
Facility
|
OP
|
$20.74
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
900912667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$58.67 |
| Rate for Payer: Adventist Health Commercial |
$4.15
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.91
|
| Rate for Payer: Blue Shield of California Commercial |
$12.59
|
| Rate for Payer: Blue Shield of California EPN |
$8.23
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Central Health Plan Commercial |
$16.59
|
| Rate for Payer: Cigna of CA HMO |
$13.27
|
| Rate for Payer: Cigna of CA PPO |
$15.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.06
|
| Rate for Payer: EPIC Health Plan Senior |
$8.93
|
| Rate for Payer: Galaxy Health WC |
$17.63
|
| Rate for Payer: Global Benefits Group Commercial |
$12.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.93
|
| Rate for Payer: InnovAge PACE Commercial |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.97
|
| Rate for Payer: Multiplan Commercial |
$15.55
|
| Rate for Payer: Networks By Design Commercial |
$13.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.93
|
| Rate for Payer: Prime Health Services Commercial |
$17.63
|
| Rate for Payer: Prime Health Services Medicare |
$9.47
|
| Rate for Payer: Riverside University Health System MISP |
$9.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.24
|
| Rate for Payer: United Healthcare All Other HMO |
$7.24
|
| Rate for Payer: United Healthcare HMO Rider |
$7.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.82
|
| Rate for Payer: Vantage Medical Group Senior |
$8.93
|
|
|
HC SOM C-1 ESTERASE INHIBITOR ACTIVIT
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$99.03 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.10
|
| Rate for Payer: Blue Shield of California Commercial |
$10.93
|
| Rate for Payer: Blue Shield of California EPN |
$7.15
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.36
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.60
|
| Rate for Payer: InnovAge PACE Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.22
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.60
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Medicare |
$14.42
|
| Rate for Payer: Riverside University Health System MISP |
$14.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.02
|
| Rate for Payer: United Healthcare All Other HMO |
$11.02
|
| Rate for Payer: United Healthcare HMO Rider |
$11.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13.60
|
|
|
HC SOM C-1 ESTERASE INHIBITOR ACTIVIT
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
900911175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC SOM C1 EXTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM C1 EXTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900912844
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$94.18 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.11
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: InnovAge PACE Commercial |
$25.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM CA 27.29
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.90
|
| Rate for Payer: EPIC Health Plan Senior |
$5.90
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
|
|
HC SOM CA 27.29
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
900911430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$151.29 |
| Rate for Payer: Adventist Health Commercial |
$2.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.96
|
| 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 Exchange |
$151.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8.95
|
| Rate for Payer: Blue Shield of California EPN |
$5.86
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Cash Price |
$14.75
|
| Rate for Payer: Central Health Plan Commercial |
$11.80
|
| Rate for Payer: Cigna of CA HMO |
$9.44
|
| Rate for Payer: Cigna of CA PPO |
$10.91
|
| 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: EPIC Health Plan Commercial |
$28.09
|
| Rate for Payer: EPIC Health Plan Senior |
$20.81
|
| Rate for Payer: Galaxy Health WC |
$12.54
|
| Rate for Payer: Global Benefits Group Commercial |
$8.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: InnovAge PACE Commercial |
$31.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$11.06
|
| Rate for Payer: Networks By Design Commercial |
$9.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.54
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Riverside University Health System MISP |
$22.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.85
|
| 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 CADMIUM WHOLE BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$168.28 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.15
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.91
|
| Rate for Payer: EPIC Health Plan Senior |
$23.64
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.64
|
| Rate for Payer: InnovAge PACE Commercial |
$35.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23.64
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$25.06
|
| Rate for Payer: Riverside University Health System MISP |
$26.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.15
|
| Rate for Payer: United Healthcare All Other HMO |
$19.15
|
| Rate for Payer: United Healthcare HMO Rider |
$19.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$23.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.00
|
| Rate for Payer: Vantage Medical Group Senior |
$23.64
|
|
|
HC SOM CADMIUM WHOLE BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
900911051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
|
IP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$69.26 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Central Health Plan Commercial |
$61.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.78
|
| Rate for Payer: EPIC Health Plan Senior |
$30.78
|
| Rate for Payer: Galaxy Health WC |
$65.42
|
| Rate for Payer: Global Benefits Group Commercial |
$46.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.39
|
| Rate for Payer: Multiplan Commercial |
$57.72
|
| Rate for Payer: Networks By Design Commercial |
$50.02
|
| Rate for Payer: Prime Health Services Commercial |
$65.42
|
|
|
HC SOM CAH 11-DESOXYCORTISOL
|
Facility
|
OP
|
$76.96
|
|
|
Service Code
|
CPT 82634
|
| Hospital Charge Code |
900912775
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.21
|
| Rate for Payer: Blue Shield of California Commercial |
$46.71
|
| Rate for Payer: Blue Shield of California EPN |
$30.55
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Cash Price |
$76.96
|
| Rate for Payer: Central Health Plan Commercial |
$61.57
|
| Rate for Payer: Cigna of CA HMO |
$49.25
|
| Rate for Payer: Cigna of CA PPO |
$56.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Senior |
$29.28
|
| Rate for Payer: Galaxy Health WC |
$65.42
|
| Rate for Payer: Global Benefits Group Commercial |
$46.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: InnovAge PACE Commercial |
$43.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$57.72
|
| Rate for Payer: Networks By Design Commercial |
$50.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.28
|
| Rate for Payer: Prime Health Services Commercial |
$65.42
|
| Rate for Payer: Prime Health Services Medicare |
$31.04
|
| Rate for Payer: Riverside University Health System MISP |
$32.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.71
|
| Rate for Payer: United Healthcare All Other HMO |
$23.71
|
| Rate for Payer: United Healthcare HMO Rider |
$23.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
|
OP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$197.62 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.11
|
| Rate for Payer: Blue Shield of California Commercial |
$43.35
|
| Rate for Payer: Blue Shield of California EPN |
$28.35
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Central Health Plan Commercial |
$57.13
|
| Rate for Payer: Cigna of CA HMO |
$45.70
|
| Rate for Payer: Cigna of CA PPO |
$52.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.68
|
| Rate for Payer: EPIC Health Plan Senior |
$27.17
|
| Rate for Payer: Galaxy Health WC |
$60.70
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.17
|
| Rate for Payer: InnovAge PACE Commercial |
$40.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.41
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.17
|
| Rate for Payer: Prime Health Services Commercial |
$60.70
|
| Rate for Payer: Prime Health Services Medicare |
$28.80
|
| Rate for Payer: Riverside University Health System MISP |
$29.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.89
|
| Rate for Payer: Vantage Medical Group Senior |
$27.17
|
|
|
HC SOM CAH 17-ALPHA-OH PROGESTERONE
|
Facility
|
IP
|
$71.41
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
900912778
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.27 |
| Rate for Payer: Adventist Health Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Central Health Plan Commercial |
$57.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.56
|
| Rate for Payer: EPIC Health Plan Senior |
$28.56
|
| Rate for Payer: Galaxy Health WC |
$60.70
|
| Rate for Payer: Global Benefits Group Commercial |
$42.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$53.56
|
| Rate for Payer: Networks By Design Commercial |
$46.42
|
| Rate for Payer: Prime Health Services Commercial |
$60.70
|
|
|
HC SOM CAH 17-OH PREGNENOLONE
|
Facility
|
OP
|
$59.95
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
900912776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$166.03 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.70
|
| Rate for Payer: Blue Shield of California Commercial |
$36.39
|
| Rate for Payer: Blue Shield of California EPN |
$23.80
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Central Health Plan Commercial |
$47.96
|
| Rate for Payer: Cigna of CA HMO |
$38.37
|
| Rate for Payer: Cigna of CA PPO |
$44.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.79
|
| Rate for Payer: EPIC Health Plan Senior |
$22.81
|
| Rate for Payer: Galaxy Health WC |
$50.96
|
| Rate for Payer: Global Benefits Group Commercial |
$35.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.81
|
| Rate for Payer: InnovAge PACE Commercial |
$34.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.57
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
| Rate for Payer: Networks By Design Commercial |
$38.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.81
|
| Rate for Payer: Prime Health Services Commercial |
$50.96
|
| Rate for Payer: Prime Health Services Medicare |
$24.18
|
| Rate for Payer: Riverside University Health System MISP |
$25.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.48
|
| Rate for Payer: United Healthcare All Other HMO |
$18.48
|
| Rate for Payer: United Healthcare HMO Rider |
$18.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.09
|
| Rate for Payer: Vantage Medical Group Senior |
$22.81
|
|
|
HC SOM CAH 17-OH PREGNENOLONE
|
Facility
|
IP
|
$59.95
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
900912776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$59.95
|
| Rate for Payer: Central Health Plan Commercial |
$47.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.96
|
| Rate for Payer: Global Benefits Group Commercial |
$35.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
| Rate for Payer: Networks By Design Commercial |
$38.97
|
| Rate for Payer: Prime Health Services Commercial |
$50.96
|
|
|
HC SOM CAH ANDROSTENEDIONE
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900912771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.21
|
| Rate for Payer: Blue Shield of California Commercial |
$46.71
|
| Rate for Payer: Blue Shield of California EPN |
$30.55
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$61.56
|
| Rate for Payer: Cigna of CA HMO |
$49.25
|
| Rate for Payer: Cigna of CA PPO |
$56.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.53
|
| Rate for Payer: EPIC Health Plan Senior |
$29.28
|
| Rate for Payer: Galaxy Health WC |
$65.41
|
| Rate for Payer: Global Benefits Group Commercial |
$46.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.28
|
| Rate for Payer: InnovAge PACE Commercial |
$43.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$57.71
|
| Rate for Payer: Networks By Design Commercial |
$50.02
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.28
|
| Rate for Payer: Prime Health Services Commercial |
$65.41
|
| Rate for Payer: Prime Health Services Medicare |
$31.04
|
| Rate for Payer: Riverside University Health System MISP |
$32.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.71
|
| Rate for Payer: United Healthcare All Other HMO |
$23.71
|
| Rate for Payer: United Healthcare HMO Rider |
$23.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.28
|
|
|
HC SOM CAH ANDROSTENEDIONE
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
900912771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Adventist Health Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$61.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.78
|
| Rate for Payer: EPIC Health Plan Senior |
$30.78
|
| Rate for Payer: Galaxy Health WC |
$65.41
|
| Rate for Payer: Global Benefits Group Commercial |
$46.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.39
|
| Rate for Payer: Multiplan Commercial |
$57.71
|
| Rate for Payer: Networks By Design Commercial |
$50.02
|
| Rate for Payer: Prime Health Services Commercial |
$65.41
|
|
|
HC SOM CAH CORTISOL
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$118.72 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.09
|
| Rate for Payer: Blue Shield of California Commercial |
$26.00
|
| Rate for Payer: Blue Shield of California EPN |
$17.01
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Central Health Plan Commercial |
$34.27
|
| Rate for Payer: Cigna of CA HMO |
$27.42
|
| Rate for Payer: Cigna of CA PPO |
$31.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.30
|
| Rate for Payer: Galaxy Health WC |
$36.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.30
|
| Rate for Payer: InnovAge PACE Commercial |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$32.13
|
| Rate for Payer: Networks By Design Commercial |
$27.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.30
|
| Rate for Payer: Prime Health Services Commercial |
$36.41
|
| Rate for Payer: Prime Health Services Medicare |
$17.28
|
| Rate for Payer: Riverside University Health System MISP |
$17.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.20
|
| Rate for Payer: United Healthcare All Other HMO |
$13.20
|
| Rate for Payer: United Healthcare HMO Rider |
$13.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$16.30
|
|
|
HC SOM CAH CORTISOL
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
900912772
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Adventist Health Commercial |
$8.57
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Central Health Plan Commercial |
$34.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.14
|
| Rate for Payer: EPIC Health Plan Senior |
$17.14
|
| Rate for Payer: Galaxy Health WC |
$36.41
|
| Rate for Payer: Global Benefits Group Commercial |
$25.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$32.13
|
| Rate for Payer: Networks By Design Commercial |
$27.85
|
| Rate for Payer: Prime Health Services Commercial |
$36.41
|
|
|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Central Health Plan Commercial |
$53.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.56
|
| Rate for Payer: EPIC Health Plan Senior |
$26.56
|
| Rate for Payer: Galaxy Health WC |
$56.45
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.45
|
|
|
HC SOM CAH DEHYDROEPIANDROSTERONE
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
900912774
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$183.86 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.31
|
| Rate for Payer: Blue Shield of California Commercial |
$40.31
|
| Rate for Payer: Blue Shield of California EPN |
$26.36
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Central Health Plan Commercial |
$53.13
|
| Rate for Payer: Cigna of CA HMO |
$42.50
|
| Rate for Payer: Cigna of CA PPO |
$49.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.11
|
| Rate for Payer: EPIC Health Plan Senior |
$25.27
|
| Rate for Payer: Galaxy Health WC |
$56.45
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.27
|
| Rate for Payer: InnovAge PACE Commercial |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.86
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.27
|
| Rate for Payer: Prime Health Services Commercial |
$56.45
|
| Rate for Payer: Prime Health Services Medicare |
$26.79
|
| Rate for Payer: Riverside University Health System MISP |
$27.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.47
|
| Rate for Payer: United Healthcare All Other HMO |
$20.47
|
| Rate for Payer: United Healthcare HMO Rider |
$20.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.80
|
| Rate for Payer: Vantage Medical Group Senior |
$25.27
|
|
