|
HC SOM VITAMIN A
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$84.34 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.12
|
| Rate for Payer: Blue Shield of California Commercial |
$10.87
|
| Rate for Payer: Blue Shield of California EPN |
$7.11
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.67
|
| Rate for Payer: EPIC Health Plan Senior |
$11.61
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.61
|
| Rate for Payer: InnovAge PACE Commercial |
$17.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.56
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.61
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
| Rate for Payer: Prime Health Services Medicare |
$12.31
|
| Rate for Payer: Riverside University Health System MISP |
$12.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.40
|
| Rate for Payer: United Healthcare All Other HMO |
$9.40
|
| Rate for Payer: United Healthcare HMO Rider |
$9.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.77
|
| Rate for Payer: Vantage Medical Group Senior |
$11.61
|
|
|
HC SOM VITAMIN A
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
900911173
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: EPIC Health Plan Senior |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$13.43
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
|
|
HC SOM VITAMIN B1 (THIAMINE)
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SOM VITAMIN B1 (THIAMINE)
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
900911048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$131.21 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.63
|
| Rate for Payer: Blue Shield of California Commercial |
$13.35
|
| Rate for Payer: Blue Shield of California EPN |
$8.73
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.66
|
| Rate for Payer: EPIC Health Plan Senior |
$21.23
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.23
|
| Rate for Payer: InnovAge PACE Commercial |
$31.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.45
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.23
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$22.50
|
| Rate for Payer: Riverside University Health System MISP |
$23.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.20
|
| Rate for Payer: United Healthcare All Other HMO |
$17.20
|
| Rate for Payer: United Healthcare HMO Rider |
$17.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.35
|
| Rate for Payer: Vantage Medical Group Senior |
$21.23
|
|
|
HC SOM VITAMIN B6
|
Facility
|
OP
|
$28.25
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$173.48 |
| Rate for Payer: Adventist Health Commercial |
$5.65
|
| Rate for Payer: Adventist Health Medi-Cal |
$28.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$173.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.21
|
| Rate for Payer: Blue Shield of California Commercial |
$17.15
|
| Rate for Payer: Blue Shield of California EPN |
$11.22
|
| Rate for Payer: Cash Price |
$28.25
|
| Rate for Payer: Cash Price |
$28.25
|
| Rate for Payer: Central Health Plan Commercial |
$22.60
|
| Rate for Payer: Cigna of CA HMO |
$18.08
|
| Rate for Payer: Cigna of CA PPO |
$20.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.94
|
| Rate for Payer: EPIC Health Plan Senior |
$28.10
|
| Rate for Payer: Galaxy Health WC |
$24.01
|
| Rate for Payer: Global Benefits Group Commercial |
$16.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$46.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$28.10
|
| Rate for Payer: InnovAge PACE Commercial |
$42.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.65
|
| Rate for Payer: Multiplan Commercial |
$21.19
|
| Rate for Payer: Networks By Design Commercial |
$18.36
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$28.10
|
| Rate for Payer: Prime Health Services Commercial |
$24.01
|
| Rate for Payer: Prime Health Services Medicare |
$29.79
|
| Rate for Payer: Riverside University Health System MISP |
$30.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.76
|
| Rate for Payer: United Healthcare All Other HMO |
$22.76
|
| Rate for Payer: United Healthcare HMO Rider |
$22.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$28.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.91
|
| Rate for Payer: Vantage Medical Group Senior |
$28.10
|
|
|
HC SOM VITAMIN B6
|
Facility
|
IP
|
$28.25
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
900911400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Adventist Health Commercial |
$5.65
|
| Rate for Payer: Cash Price |
$28.25
|
| Rate for Payer: Central Health Plan Commercial |
$22.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.30
|
| Rate for Payer: EPIC Health Plan Senior |
$11.30
|
| Rate for Payer: Galaxy Health WC |
$24.01
|
| Rate for Payer: Global Benefits Group Commercial |
$16.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.65
|
| Rate for Payer: Multiplan Commercial |
$21.19
|
| Rate for Payer: Networks By Design Commercial |
$18.36
|
| Rate for Payer: Prime Health Services Commercial |
$24.01
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3.20
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
|
|
HC SOM VITAMIN D 25-HYDROXY
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900911032
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$215.35 |
| Rate for Payer: Adventist Health Commercial |
$1.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.18
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Central Health Plan Commercial |
$6.40
|
| Rate for Payer: Cigna of CA HMO |
$5.12
|
| Rate for Payer: Cigna of CA PPO |
$5.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$6.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: InnovAge PACE Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$6.00
|
| Rate for Payer: Networks By Design Commercial |
$5.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$6.80
|
| Rate for Payer: Prime Health Services Medicare |
$31.38
|
| Rate for Payer: Riverside University Health System MISP |
$32.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC SOM VITAMIN E
|
Facility
|
OP
|
$19.57
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$103.10 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$103.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.92
|
| Rate for Payer: Blue Shield of California Commercial |
$11.88
|
| Rate for Payer: Blue Shield of California EPN |
$7.77
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Central Health Plan Commercial |
$15.66
|
| Rate for Payer: Cigna of CA HMO |
$12.52
|
| Rate for Payer: Cigna of CA PPO |
$14.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.14
|
| Rate for Payer: EPIC Health Plan Senior |
$14.18
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.18
|
| Rate for Payer: InnovAge PACE Commercial |
$21.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.00
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.18
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Medicare |
$15.03
|
| Rate for Payer: Riverside University Health System MISP |
$15.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.48
|
| Rate for Payer: United Healthcare All Other HMO |
$11.48
|
| Rate for Payer: United Healthcare HMO Rider |
$11.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14.18
|
|
|
HC SOM VITAMIN E
|
Facility
|
IP
|
$19.57
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
900911174
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$17.61 |
| Rate for Payer: Adventist Health Commercial |
$3.91
|
| Rate for Payer: Cash Price |
$19.57
|
| Rate for Payer: Central Health Plan Commercial |
$15.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.83
|
| Rate for Payer: EPIC Health Plan Senior |
$7.83
|
| Rate for Payer: Galaxy Health WC |
$16.63
|
| Rate for Payer: Global Benefits Group Commercial |
$11.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Multiplan Commercial |
$14.68
|
| Rate for Payer: Networks By Design Commercial |
$12.72
|
| Rate for Payer: Prime Health Services Commercial |
$16.63
|
|
|
HC SOM VITAMIN K
|
Facility
|
IP
|
$45.65
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Cash Price |
$45.65
|
| Rate for Payer: Central Health Plan Commercial |
$36.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.26
|
| Rate for Payer: EPIC Health Plan Senior |
$18.26
|
| Rate for Payer: Galaxy Health WC |
$38.80
|
| Rate for Payer: Global Benefits Group Commercial |
$27.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$34.24
|
| Rate for Payer: Networks By Design Commercial |
$29.67
|
| Rate for Payer: Prime Health Services Commercial |
$38.80
|
|
|
HC SOM VITAMIN K
|
Facility
|
OP
|
$45.65
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
900911429
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.13 |
| Max. Negotiated Rate |
$96.48 |
| Rate for Payer: Adventist Health Commercial |
$9.13
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.58
|
| Rate for Payer: Blue Shield of California Commercial |
$27.71
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$45.65
|
| Rate for Payer: Cash Price |
$45.65
|
| Rate for Payer: Central Health Plan Commercial |
$36.52
|
| Rate for Payer: Cigna of CA HMO |
$29.22
|
| Rate for Payer: Cigna of CA PPO |
$33.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.52
|
| Rate for Payer: EPIC Health Plan Senior |
$13.72
|
| Rate for Payer: Galaxy Health WC |
$38.80
|
| Rate for Payer: Global Benefits Group Commercial |
$27.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.72
|
| Rate for Payer: InnovAge PACE Commercial |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.38
|
| Rate for Payer: Multiplan Commercial |
$34.24
|
| Rate for Payer: Networks By Design Commercial |
$29.67
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.72
|
| Rate for Payer: Prime Health Services Commercial |
$38.80
|
| Rate for Payer: Prime Health Services Medicare |
$14.54
|
| Rate for Payer: Riverside University Health System MISP |
$15.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.09
|
| Rate for Payer: Vantage Medical Group Senior |
$13.72
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM VOLATILES BLOOD
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910583
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.31
|
| Rate for Payer: Blue Shield of California Commercial |
$27.32
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: InnovAge PACE Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.50
|
| 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: Riverside University Health System MISP |
$18.00
|
| 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 |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM VOLATILES URINE
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM VOLATILES URINE
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
900910584
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$75.42 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$75.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.31
|
| Rate for Payer: Blue Shield of California Commercial |
$27.32
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: InnovAge PACE Commercial |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.50
|
| 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: Riverside University Health System MISP |
$18.00
|
| 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 |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC SOM VONWILLEBRAND AG
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
900910112
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$166.91 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.88
|
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| Rate for Payer: Blue Shield of California EPN |
$10.06
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: InnovAge PACE Commercial |
$34.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.94
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Prime Health Services Medicare |
$24.32
|
| Rate for Payer: Riverside University Health System MISP |
$25.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
IP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Adventist Health Commercial |
$14.84
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Central Health Plan Commercial |
$59.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.68
|
| Rate for Payer: EPIC Health Plan Senior |
$29.68
|
| Rate for Payer: Galaxy Health WC |
$63.07
|
| Rate for Payer: Global Benefits Group Commercial |
$44.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$55.65
|
| Rate for Payer: Networks By Design Commercial |
$48.23
|
| Rate for Payer: Prime Health Services Commercial |
$63.07
|
|
|
HC SOM VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
OP
|
$74.20
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
900912874
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$166.42 |
| Rate for Payer: Adventist Health Commercial |
$14.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.78
|
| Rate for Payer: Blue Shield of California Commercial |
$45.04
|
| Rate for Payer: Blue Shield of California EPN |
$29.46
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Central Health Plan Commercial |
$59.36
|
| Rate for Payer: Cigna of CA HMO |
$47.49
|
| Rate for Payer: Cigna of CA PPO |
$54.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Senior |
$30.86
|
| Rate for Payer: Galaxy Health WC |
$63.07
|
| Rate for Payer: Global Benefits Group Commercial |
$44.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$50.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.86
|
| Rate for Payer: InnovAge PACE Commercial |
$46.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.35
|
| Rate for Payer: Multiplan Commercial |
$55.65
|
| Rate for Payer: Networks By Design Commercial |
$48.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$30.86
|
| Rate for Payer: Prime Health Services Commercial |
$63.07
|
| Rate for Payer: Prime Health Services Medicare |
$32.71
|
| Rate for Payer: Riverside University Health System MISP |
$33.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.99
|
| Rate for Payer: United Healthcare All Other HMO |
$24.99
|
| Rate for Payer: United Healthcare HMO Rider |
$24.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.95
|
| Rate for Payer: Vantage Medical Group Senior |
$30.86
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
OP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$166.91 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$166.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.88
|
| Rate for Payer: Blue Shield of California Commercial |
$31.02
|
| Rate for Payer: Blue Shield of California EPN |
$20.29
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Central Health Plan Commercial |
$40.88
|
| Rate for Payer: Cigna of CA HMO |
$32.70
|
| Rate for Payer: Cigna of CA PPO |
$37.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.97
|
| Rate for Payer: EPIC Health Plan Senior |
$22.94
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.99
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.94
|
| Rate for Payer: InnovAge PACE Commercial |
$34.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.74
|
| Rate for Payer: Multiplan Commercial |
$38.33
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.94
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
| Rate for Payer: Prime Health Services Medicare |
$24.32
|
| Rate for Payer: Riverside University Health System MISP |
$25.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.59
|
| Rate for Payer: United Healthcare All Other HMO |
$18.59
|
| Rate for Payer: United Healthcare HMO Rider |
$18.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.23
|
| Rate for Payer: Vantage Medical Group Senior |
$22.94
|
|
|
HC SOM VON WILLEBRAND FACTOR MULTIMER P
|
Facility
|
IP
|
$51.10
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
900910113
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$45.99 |
| Rate for Payer: Adventist Health Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$51.10
|
| Rate for Payer: Central Health Plan Commercial |
$40.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.44
|
| Rate for Payer: EPIC Health Plan Senior |
$20.44
|
| Rate for Payer: Galaxy Health WC |
$43.44
|
| Rate for Payer: Global Benefits Group Commercial |
$30.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.22
|
| Rate for Payer: Multiplan Commercial |
$38.33
|
| Rate for Payer: Networks By Design Commercial |
$33.22
|
| Rate for Payer: Prime Health Services Commercial |
$43.44
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
OP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$27.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.18
|
| Rate for Payer: Blue Shield of California Commercial |
$16.46
|
| Rate for Payer: Blue Shield of California EPN |
$10.76
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: Cigna of CA HMO |
$17.35
|
| Rate for Payer: Cigna of CA PPO |
$20.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.11
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.11
|
| Rate for Payer: InnovAge PACE Commercial |
$40.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.33
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$27.11
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
| Rate for Payer: Prime Health Services Medicare |
$28.74
|
| Rate for Payer: Riverside University Health System MISP |
$29.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.96
|
| Rate for Payer: United Healthcare All Other HMO |
$21.96
|
| Rate for Payer: United Healthcare HMO Rider |
$21.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.96
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.82
|
| Rate for Payer: Vantage Medical Group Senior |
$27.11
|
|
|
HC SOM VORICONAZOLE LEVEL
|
Facility
|
IP
|
$27.11
|
|
|
Service Code
|
CPT 80285
|
| Hospital Charge Code |
900912707
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$24.40 |
| Rate for Payer: Adventist Health Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Central Health Plan Commercial |
$21.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.84
|
| Rate for Payer: EPIC Health Plan Senior |
$10.84
|
| Rate for Payer: Galaxy Health WC |
$23.04
|
| Rate for Payer: Global Benefits Group Commercial |
$16.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.42
|
| Rate for Payer: Multiplan Commercial |
$20.33
|
| Rate for Payer: Networks By Design Commercial |
$17.62
|
| Rate for Payer: Prime Health Services Commercial |
$23.04
|
|
|
HC SOM VPHIV 87900
|
Facility
|
IP
|
$174.30
|
|
|
Service Code
|
CPT 87900
|
| Hospital Charge Code |
900914741
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$34.86 |
| Max. Negotiated Rate |
$156.87 |
| Rate for Payer: Adventist Health Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Central Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.72
|
| Rate for Payer: EPIC Health Plan Senior |
$69.72
|
| Rate for Payer: Galaxy Health WC |
$148.16
|
| Rate for Payer: Global Benefits Group Commercial |
$104.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$156.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.86
|
| Rate for Payer: Multiplan Commercial |
$130.72
|
| Rate for Payer: Networks By Design Commercial |
$113.30
|
| Rate for Payer: Prime Health Services Commercial |
$148.16
|
|
