|
HC SOM CONTROLLED SUB MON 1
|
Facility
|
IP
|
$16.60
|
|
|
Service Code
|
CPT 80364
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$14.94 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.64
|
| Rate for Payer: Galaxy Health WC |
$14.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Multiplan Commercial |
$12.45
|
| Rate for Payer: Networks By Design Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$14.11
|
|
|
HC SOM CONTROLLED SUB MON 1
|
Facility
|
OP
|
$16.60
|
|
|
Service Code
|
CPT 80364
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$162.95 |
| Rate for Payer: Adventist Health Commercial |
$3.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.07
|
| Rate for Payer: Blue Shield of California Commercial |
$10.08
|
| Rate for Payer: Blue Shield of California EPN |
$6.59
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Central Health Plan Commercial |
$13.28
|
| Rate for Payer: Cigna of CA HMO |
$10.62
|
| Rate for Payer: Cigna of CA PPO |
$12.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: EPIC Health Plan Senior |
$6.64
|
| Rate for Payer: Galaxy Health WC |
$14.11
|
| Rate for Payer: Global Benefits Group Commercial |
$9.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.94
|
| Rate for Payer: InnovAge PACE Commercial |
$8.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.62
|
| Rate for Payer: Multiplan Commercial |
$12.45
|
| Rate for Payer: Networks By Design Commercial |
$10.79
|
| Rate for Payer: Prime Health Services Commercial |
$14.11
|
| Rate for Payer: Riverside University Health System MISP |
$6.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.30
|
| Rate for Payer: United Healthcare All Other HMO |
$8.30
|
| Rate for Payer: United Healthcare HMO Rider |
$8.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.11
|
| Rate for Payer: Vantage Medical Group Senior |
$14.11
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
OP
|
$64.77
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$39.32
|
| Rate for Payer: Blue Shield of California EPN |
$25.71
|
| Rate for Payer: Cash Price |
$64.77
|
| Rate for Payer: Cash Price |
$64.77
|
| Rate for Payer: Central Health Plan Commercial |
$51.82
|
| Rate for Payer: Cigna of CA HMO |
$41.45
|
| Rate for Payer: Cigna of CA PPO |
$47.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$55.05
|
| Rate for Payer: Global Benefits Group Commercial |
$38.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$48.58
|
| Rate for Payer: Networks By Design Commercial |
$42.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$55.05
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
IP
|
$64.77
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Cash Price |
$64.77
|
| Rate for Payer: Central Health Plan Commercial |
$51.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.91
|
| Rate for Payer: EPIC Health Plan Senior |
$25.91
|
| Rate for Payer: Galaxy Health WC |
$55.05
|
| Rate for Payer: Global Benefits Group Commercial |
$38.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.95
|
| Rate for Payer: Multiplan Commercial |
$48.58
|
| Rate for Payer: Networks By Design Commercial |
$42.10
|
| Rate for Payer: Prime Health Services Commercial |
$55.05
|
|
|
HC SOM CONTROLLED SUB MON 3
|
Facility
|
OP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$141.94 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.81
|
| Rate for Payer: Blue Shield of California Commercial |
$14.57
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.21
|
| Rate for Payer: Cigna of CA HMO |
$15.37
|
| Rate for Payer: Cigna of CA PPO |
$17.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.41
|
| Rate for Payer: Global Benefits Group Commercial |
$14.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.61
|
| Rate for Payer: InnovAge PACE Commercial |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$18.01
|
| Rate for Payer: Networks By Design Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Commercial |
$20.41
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.01
|
| Rate for Payer: United Healthcare All Other HMO |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.41
|
| Rate for Payer: Vantage Medical Group Senior |
$20.41
|
|
|
HC SOM CONTROLLED SUB MON 3
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.41
|
| Rate for Payer: Global Benefits Group Commercial |
$14.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.01
|
| Rate for Payer: Networks By Design Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Commercial |
$20.41
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
OP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$130.13 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.41
|
| Rate for Payer: Blue Shield of California Commercial |
$5.84
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Central Health Plan Commercial |
$7.70
|
| Rate for Payer: Cigna of CA HMO |
$6.16
|
| Rate for Payer: Cigna of CA PPO |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.85
|
| Rate for Payer: EPIC Health Plan Senior |
$3.85
|
| Rate for Payer: Galaxy Health WC |
$8.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.66
|
| Rate for Payer: InnovAge PACE Commercial |
$4.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
| Rate for Payer: Riverside University Health System MISP |
$3.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO |
$4.81
|
| Rate for Payer: United Healthcare HMO Rider |
$4.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.18
|
| Rate for Payer: Vantage Medical Group Senior |
$8.18
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
IP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Central Health Plan Commercial |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.85
|
| Rate for Payer: EPIC Health Plan Senior |
$3.85
|
| Rate for Payer: Galaxy Health WC |
$8.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
|
|
HC SOM COPPER LIVER TISSUE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.37
|
| Rate for Payer: Blue Shield of California Commercial |
$39.45
|
| Rate for Payer: Blue Shield of California EPN |
$25.80
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Senior |
$12.41
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: InnovAge PACE Commercial |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Riverside University Health System MISP |
$13.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER LIVER TISSUE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC SOM COPPER SERUM
|
Facility
|
OP
|
$14.32
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.37
|
| Rate for Payer: Blue Shield of California Commercial |
$8.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Central Health Plan Commercial |
$11.46
|
| Rate for Payer: Cigna of CA HMO |
$9.16
|
| Rate for Payer: Cigna of CA PPO |
$10.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Senior |
$12.41
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: InnovAge PACE Commercial |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Riverside University Health System MISP |
$13.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER SERUM
|
Facility
|
IP
|
$14.32
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$2.86
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Central Health Plan Commercial |
$11.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.73
|
| Rate for Payer: EPIC Health Plan Senior |
$5.73
|
| Rate for Payer: Galaxy Health WC |
$12.17
|
| Rate for Payer: Global Benefits Group Commercial |
$8.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.86
|
| Rate for Payer: Multiplan Commercial |
$10.74
|
| Rate for Payer: Networks By Design Commercial |
$9.31
|
| Rate for Payer: Prime Health Services Commercial |
$12.17
|
|
|
HC SOM COPPER URINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM COPPER URINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.37
|
| Rate for Payer: Blue Shield of California Commercial |
$27.32
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Senior |
$12.41
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: InnovAge PACE Commercial |
$18.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Riverside University Health System MISP |
$13.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
IP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$17.97 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Central Health Plan Commercial |
$15.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.99
|
| Rate for Payer: EPIC Health Plan Senior |
$7.99
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Networks By Design Commercial |
$12.98
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
OP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$130.82 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$12.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Central Health Plan Commercial |
$15.98
|
| Rate for Payer: Cigna of CA HMO |
$12.78
|
| Rate for Payer: Cigna of CA PPO |
$14.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: EPIC Health Plan Senior |
$24.11
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: InnovAge PACE Commercial |
$36.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Networks By Design Commercial |
$12.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.11
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Riverside University Health System MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM CORTISOL FREE RANDOM UR
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM CORTISOL FREE RANDOM UR
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$123.37 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.56
|
| Rate for Payer: EPIC Health Plan Senior |
$16.71
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: InnovAge PACE Commercial |
$25.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.71
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Riverside University Health System MISP |
$18.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$123.37 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.56
|
| Rate for Payer: EPIC Health Plan Senior |
$16.71
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: InnovAge PACE Commercial |
$25.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.71
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Riverside University Health System MISP |
$18.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$38.00
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC SOM CORTISOL FREE UR
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$123.37 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.56
|
| Rate for Payer: EPIC Health Plan Senior |
$16.71
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: InnovAge PACE Commercial |
$25.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.71
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Riverside University Health System MISP |
$18.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE UR
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM CORTISOL FREE URINE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$123.37 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.56
|
| Rate for Payer: EPIC Health Plan Senior |
$16.71
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: InnovAge PACE Commercial |
$25.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.71
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Riverside University Health System MISP |
$18.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE URINE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM COUMADIN LEVEL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
