|
HC SOM COUMADIN LEVEL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$125.72 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.52
|
| Rate for Payer: Blue Shield of California Commercial |
$66.16
|
| Rate for Payer: Blue Shield of California EPN |
$43.27
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: 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: InnovAge PACE Commercial |
$54.50
|
| 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: Molina Healthcare of CA Medi-Cal |
$76.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.30
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$43.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.50
|
| Rate for Payer: United Healthcare All Other HMO |
$54.50
|
| Rate for Payer: United Healthcare HMO Rider |
$54.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$91.83 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.64
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.98
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.36
|
| Rate for Payer: EPIC Health Plan Senior |
$12.12
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: InnovAge PACE Commercial |
$18.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.12
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Medicare |
$12.85
|
| Rate for Payer: Riverside University Health System MISP |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$123.37 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.29
|
| 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 |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.04
|
| Rate for Payer: Blue Shield of California Commercial |
$7.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| 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 |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.67
|
| 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 |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| 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 |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.81
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| 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 |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
IP
|
$9.65
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Central Health Plan Commercial |
$7.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Senior |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Networks By Design Commercial |
$6.27
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
OP
|
$9.65
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.05
|
| Rate for Payer: Blue Shield of California Commercial |
$5.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Central Health Plan Commercial |
$7.72
|
| Rate for Payer: Cigna of CA HMO |
$6.18
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.96
|
| Rate for Payer: EPIC Health Plan Senior |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: InnovAge PACE Commercial |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Networks By Design Commercial |
$6.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.53
|
| Rate for Payer: Riverside University Health System MISP |
$13.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO |
$9.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: Cigna of CA HMO |
$6.62
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.12
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: InnovAge PACE Commercial |
$19.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Prime Health Services Medicare |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$13.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
IP
|
$9.65
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$8.69 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Central Health Plan Commercial |
$7.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.86
|
| Rate for Payer: EPIC Health Plan Senior |
$3.86
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Networks By Design Commercial |
$6.27
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
OP
|
$9.65
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Adventist Health Commercial |
$1.93
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.05
|
| Rate for Payer: Blue Shield of California Commercial |
$5.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Central Health Plan Commercial |
$7.72
|
| Rate for Payer: Cigna of CA HMO |
$6.18
|
| Rate for Payer: Cigna of CA PPO |
$7.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.96
|
| Rate for Payer: EPIC Health Plan Senior |
$11.82
|
| Rate for Payer: Galaxy Health WC |
$8.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.69
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: InnovAge PACE Commercial |
$17.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$7.24
|
| Rate for Payer: Networks By Design Commercial |
$6.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.82
|
| Rate for Payer: Prime Health Services Commercial |
$8.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.53
|
| Rate for Payer: Riverside University Health System MISP |
$13.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO |
$9.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
OP
|
$10.35
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$93.89 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.11
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: Cigna of CA HMO |
$6.62
|
| Rate for Payer: Cigna of CA PPO |
$7.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.12
|
| Rate for Payer: EPIC Health Plan Senior |
$12.68
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: InnovAge PACE Commercial |
$19.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
| Rate for Payer: Prime Health Services Medicare |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$13.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Adventist Health Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$8.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4.14
|
| Rate for Payer: Galaxy Health WC |
$8.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.07
|
| Rate for Payer: Multiplan Commercial |
$7.76
|
| Rate for Payer: Networks By Design Commercial |
$6.73
|
| Rate for Payer: Prime Health Services Commercial |
$8.80
|
|
|
HC SOM CREATININE RANDOM, U
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
|
|
HC SOM CREATININE RANDOM, U
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$4.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: InnovAge PACE Commercial |
$7.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.66
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.09
|
| Rate for Payer: EPIC Health Plan Senior |
$14.14
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: InnovAge PACE Commercial |
$21.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.14
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$14.99
|
| Rate for Payer: Riverside University Health System MISP |
$15.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$45.84 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Senior |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: InnovAge PACE Commercial |
$9.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$65.38 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.27
|
| Rate for Payer: Blue Shield of California Commercial |
$24.28
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.66
|
| Rate for Payer: EPIC Health Plan Senior |
$13.82
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.82
|
| Rate for Payer: InnovAge PACE Commercial |
$20.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.82
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.65
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.20
|
| Rate for Payer: United Healthcare All Other HMO |
$11.20
|
| Rate for Payer: United Healthcare HMO Rider |
$11.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
OP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$37.61 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.63
|
| Rate for Payer: Blue Shield of California Commercial |
$5.26
|
| Rate for Payer: Blue Shield of California EPN |
$3.44
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Central Health Plan Commercial |
$6.93
|
| Rate for Payer: Cigna of CA HMO |
$5.54
|
| Rate for Payer: Cigna of CA PPO |
$6.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.78
|
| Rate for Payer: Galaxy Health WC |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.78
|
| Rate for Payer: InnovAge PACE Commercial |
$11.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$5.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.78
|
| Rate for Payer: Prime Health Services Commercial |
$7.36
|
| Rate for Payer: Prime Health Services Medicare |
$8.25
|
| Rate for Payer: Riverside University Health System MISP |
$8.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.30
|
| Rate for Payer: United Healthcare All Other HMO |
$6.30
|
| Rate for Payer: United Healthcare HMO Rider |
$6.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.56
|
| Rate for Payer: Vantage Medical Group Senior |
$7.78
|
|
|
HC SOM CSF IGG INDEX ALB CSF
|
Facility
|
IP
|
$8.66
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
900914411
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$7.79 |
| Rate for Payer: Adventist Health Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$8.66
|
| Rate for Payer: Central Health Plan Commercial |
$6.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.46
|
| Rate for Payer: EPIC Health Plan Senior |
$3.46
|
| Rate for Payer: Galaxy Health WC |
$7.36
|
| Rate for Payer: Global Benefits Group Commercial |
$5.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.73
|
| Rate for Payer: Multiplan Commercial |
$6.50
|
| Rate for Payer: Networks By Design Commercial |
$5.63
|
| Rate for Payer: Prime Health Services Commercial |
$7.36
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
OP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$36.05 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.34
|
| Rate for Payer: Blue Shield of California EPN |
$2.19
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Central Health Plan Commercial |
$4.41
|
| Rate for Payer: Cigna of CA HMO |
$3.53
|
| Rate for Payer: Cigna of CA PPO |
$4.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.68
|
| Rate for Payer: EPIC Health Plan Senior |
$4.95
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.95
|
| Rate for Payer: InnovAge PACE Commercial |
$7.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.95
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
| Rate for Payer: Prime Health Services Medicare |
$5.25
|
| Rate for Payer: Riverside University Health System MISP |
$5.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.01
|
| Rate for Payer: United Healthcare All Other HMO |
$4.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC SOM CSF IGG INDEX ALB S
|
Facility
|
IP
|
$5.51
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
900914410
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$4.96 |
| Rate for Payer: Adventist Health Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$5.51
|
| Rate for Payer: Central Health Plan Commercial |
$4.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.20
|
| Rate for Payer: Galaxy Health WC |
$4.68
|
| Rate for Payer: Global Benefits Group Commercial |
$3.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$4.13
|
| Rate for Payer: Networks By Design Commercial |
$3.58
|
| Rate for Payer: Prime Health Services Commercial |
$4.68
|
|
