|
HC SOM COMPLEMENT C-5
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 COMPLEMENT C-5
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$106.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.52
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| 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 |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.00
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: IEHP medi-cal |
$19.80
|
| Rate for Payer: IEHP Medicare Advantage |
$12.00
|
| Rate for Payer: Innovage PACE Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health MISP |
$13.20
|
| 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 |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
IP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Central Health Plan Commercial |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.53
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
OP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$180.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.24
|
| Rate for Payer: BCBS Transplant Transplant |
$8.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8.55
|
| Rate for Payer: Blue Shield of California EPN |
$6.72
|
| Rate for Payer: Caremore Medicare Advantage |
$20.32
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Central Health Plan Commercial |
$11.06
|
| Rate for Payer: Cigna of CA HMO |
$8.85
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.32
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.45
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: IEHP medi-cal |
$33.53
|
| Rate for Payer: IEHP Medicare Advantage |
$20.32
|
| Rate for Payer: Innovage PACE Commercial |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
| Rate for Payer: Prime Health Services Medicare |
$21.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.30
|
| Rate for Payer: Riverside University Health MISP |
$22.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare 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 |
$546.80
|
| Rate for Payer: BCBS Transplant Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92.70
|
| Rate for Payer: Blue Shield of California EPN |
$72.90
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: IEHP medi-cal |
$102.53
|
| Rate for Payer: IEHP Medicare Advantage |
$62.14
|
| Rate for Payer: Innovage PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| 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 |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: Riverside University Health MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| 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: 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 1
|
Facility
OP
|
$16.60
|
|
|
Service Code
|
CPT 80364
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.11
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$162.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.75
|
| Rate for Payer: BCBS Transplant Transplant |
$9.96
|
| Rate for Payer: Blue Shield of California Commercial |
$10.26
|
| Rate for Payer: Blue Shield of California EPN |
$8.07
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| 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: EPIC Health Plan Commercial |
$6.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$12.45
|
| Rate for Payer: IEHP medi-cal |
$5.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.07
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9.96
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$14.11
|
| Rate for Payer: Vantage Medical Group Senior |
$14.11
|
|
|
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: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$13.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$29.15
|
| Rate for Payer: Central Health Plan Commercial |
$51.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare 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 |
$546.80
|
| Rate for Payer: BCBS Transplant Transplant |
$38.86
|
| Rate for Payer: Blue Shield of California Commercial |
$40.03
|
| Rate for Payer: Blue Shield of California EPN |
$31.48
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$29.15
|
| 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: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$48.58
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: IEHP medi-cal |
$102.53
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$55.05
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$38.86
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 3
|
Facility
OP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$173.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.13
|
| Rate for Payer: BCBS Transplant Transplant |
$14.41
|
| Rate for Payer: Blue Shield of California Commercial |
$14.84
|
| Rate for Payer: Blue Shield of California EPN |
$11.67
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| 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: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$18.01
|
| Rate for Payer: IEHP medi-cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14.41
|
| Rate for Payer: Riverside University Health 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 |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.41
|
| Rate for Payer: Vantage Medical Group Senior |
$20.41
|
|
|
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: Cash Price |
$4.33
|
| Rate for Payer: Central Health Plan Commercial |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.22
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
|
|
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 |
$0.06 |
| Max. Negotiated Rate |
$158.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.73
|
| Rate for Payer: BCBS Transplant Transplant |
$5.77
|
| Rate for Payer: Blue Shield of California Commercial |
$5.95
|
| Rate for Payer: Blue Shield of California EPN |
$4.68
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cash Price |
$4.33
|
| 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: EPIC Health Plan Commercial |
$3.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$7.22
|
| Rate for Payer: IEHP medi-cal |
$3.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.22
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.77
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$8.18
|
| Rate for Payer: Vantage Medical Group Senior |
$8.18
|
|
|
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: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$43.36
|
| 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 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 |
$110.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: AlphaCare 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 |
$110.40
|
| Rate for Payer: BCBS Transplant Transplant |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.59
|
| Rate for Payer: Caremore Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| 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 |
$18.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: IEHP medi-cal |
$20.48
|
| Rate for Payer: IEHP Medicare Advantage |
$12.41
|
| Rate for Payer: Innovage PACE Commercial |
$18.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| 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: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
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 |
$110.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: AlphaCare 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 |
$110.40
|
| Rate for Payer: BCBS Transplant Transplant |
$8.59
|
| Rate for Payer: Blue Shield of California Commercial |
$8.85
|
| Rate for Payer: Blue Shield of California EPN |
$6.96
|
| Rate for Payer: Caremore Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$6.44
|
| Rate for Payer: Cash Price |
$6.44
|
| 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 |
$18.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: IEHP medi-cal |
$20.48
|
| Rate for Payer: IEHP Medicare Advantage |
$12.41
|
| Rate for Payer: Innovage PACE Commercial |
$18.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.55
|
| 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: Prime Health Services Commercial |
$12.17
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.59
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$18.62
|
| 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: Cash Price |
$6.44
|
| Rate for Payer: Central Health Plan Commercial |
$11.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$110.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.05
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: AlphaCare 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 |
$110.40
|
| Rate for Payer: BCBS Transplant Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27.81
|
| Rate for Payer: Blue Shield of California EPN |
$21.87
|
| Rate for Payer: Caremore Medicare Advantage |
$12.41
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| 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 |
$18.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: IEHP medi-cal |
$20.48
|
| Rate for Payer: IEHP Medicare Advantage |
$12.41
|
| Rate for Payer: Innovage PACE Commercial |
$18.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| 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: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$18.62
|
| 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
OP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: AlphaCare 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 |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$11.98
|
| Rate for Payer: Blue Shield of California Commercial |
$12.34
|
| Rate for Payer: Blue Shield of California EPN |
$9.71
|
| Rate for Payer: Caremore Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$8.99
|
| Rate for Payer: Cash Price |
$8.99
|
| 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: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$24.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$14.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: IEHP medi-cal |
$39.78
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$16.97
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.98
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$8.99
|
| Rate for Payer: Central Health Plan Commercial |
$15.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$150.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: AlphaCare 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 |
$150.49
|
| Rate for Payer: BCBS Transplant Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.15
|
| Rate for Payer: Caremore Medicare Advantage |
$16.71
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| 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 |
$25.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: IEHP medi-cal |
$27.57
|
| Rate for Payer: IEHP Medicare Advantage |
$16.71
|
| Rate for Payer: Innovage PACE Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| 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: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$25.06
|
| 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 |
$150.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.65
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: AlphaCare 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 |
$150.49
|
| Rate for Payer: BCBS Transplant Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.48
|
| Rate for Payer: Blue Shield of California EPN |
$18.47
|
| Rate for Payer: Caremore Medicare Advantage |
$16.71
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| 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 |
$25.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$28.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: IEHP medi-cal |
$27.57
|
| Rate for Payer: IEHP Medicare Advantage |
$16.71
|
| Rate for Payer: Innovage PACE Commercial |
$25.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| 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: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: Riverside University Health 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: Vantage Medical Group Commercial/Exchange |
$25.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
