|
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: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Central Health Plan Commercial |
$11.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.53
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.16
|
| 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 |
$205.43 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care 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 |
$205.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8.71
|
| Rate for Payer: Blue Shield of California EPN |
$5.49
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| 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: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.53
|
| Rate for Payer: EPIC Health Plan Senior |
$22.35
|
| 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: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
| Rate for Payer: Prime Health Services Medicare |
$21.54
|
| Rate for Payer: Riverside University Health System 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: Upland Medical Group Pediatric |
$20.32
|
| 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: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| 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 |
$623.23 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.23
|
| Rate for Payer: Blue Shield of California Commercial |
$94.50
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| 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: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM CONTROLLED SUB MON 1
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$1,666.09 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,198.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,666.09
|
| Rate for Payer: Blue Shield of California Commercial |
$40.79
|
| Rate for Payer: Blue Shield of California EPN |
$25.71
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Central Health Plan Commercial |
$51.80
|
| Rate for Payer: Cigna of CA HMO |
$41.44
|
| Rate for Payer: Cigna of CA PPO |
$47.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.92
|
| Rate for Payer: EPIC Health Plan Senior |
$218.61
|
| Rate for Payer: Galaxy Health WC |
$55.04
|
| Rate for Payer: Global Benefits Group Commercial |
$38.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.27
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$325.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$228.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$278.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$266.31
|
| Rate for Payer: Multiplan Commercial |
$48.56
|
| Rate for Payer: Networks By Design Commercial |
$42.09
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.74
|
| Rate for Payer: Prime Health Services Commercial |
$55.04
|
| Rate for Payer: Prime Health Services Medicare |
$210.66
|
| Rate for Payer: Riverside University Health System MISP |
$218.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.98
|
| Rate for Payer: United Healthcare All Other HMO |
$160.98
|
| Rate for Payer: United Healthcare HMO Rider |
$160.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.61
|
| Rate for Payer: Vantage Medical Group Senior |
$198.74
|
|
|
HC SOM CONTROLLED SUB MON 1
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
CPT G0482
|
| Hospital Charge Code |
900915354
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$58.27 |
| Rate for Payer: Adventist Health Commercial |
$12.95
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Central Health Plan Commercial |
$51.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.90
|
| Rate for Payer: EPIC Health Plan Senior |
$25.90
|
| Rate for Payer: Galaxy Health WC |
$55.04
|
| Rate for Payer: Global Benefits Group Commercial |
$38.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.95
|
| Rate for Payer: Multiplan Commercial |
$48.56
|
| Rate for Payer: Networks By Design Commercial |
$42.09
|
| Rate for Payer: Prime Health Services Commercial |
$55.04
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$623.23 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.23
|
| Rate for Payer: Blue Shield of California Commercial |
$12.76
|
| Rate for Payer: Blue Shield of California EPN |
$8.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$12.96
|
| Rate for Payer: Cigna of CA PPO |
$14.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.23
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SOM CONTROLLED SUB MON 2
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900915355
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Adventist Health Commercial |
$4.05
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
|
|
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 |
$197.32 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$141.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.32
|
| Rate for Payer: Blue Shield of California Commercial |
$15.13
|
| Rate for Payer: Blue Shield of California EPN |
$9.53
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.21
|
| Rate for Payer: Cigna of CA HMO |
$15.37
|
| Rate for Payer: Cigna of CA PPO |
$17.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.41
|
| Rate for Payer: Global Benefits Group Commercial |
$14.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$18.01
|
| Rate for Payer: Networks By Design Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Commercial |
$20.41
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.01
|
| Rate for Payer: United Healthcare All Other HMO |
$12.01
|
| Rate for Payer: United Healthcare HMO Rider |
$12.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.41
|
| Rate for Payer: Vantage Medical Group Senior |
$20.41
|
|
|
HC SOM CONTROLLED SUB MON 3
|
Facility
|
IP
|
$24.01
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
900915356
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$24.01
|
| Rate for Payer: Central Health Plan Commercial |
$19.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.41
|
| Rate for Payer: Global Benefits Group Commercial |
$14.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.01
|
| Rate for Payer: Networks By Design Commercial |
$15.61
|
| Rate for Payer: Prime Health Services Commercial |
$20.41
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
OP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$180.92 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.82
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Central Health Plan Commercial |
$7.70
|
| Rate for Payer: Cigna of CA HMO |
$6.16
|
| Rate for Payer: Cigna of CA PPO |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.85
|
| Rate for Payer: EPIC Health Plan Senior |
$3.85
|
| Rate for Payer: Galaxy Health WC |
$8.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
| Rate for Payer: Riverside University Health System MISP |
$3.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Other HMO |
$4.81
|
| Rate for Payer: United Healthcare HMO Rider |
$4.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.18
|
| Rate for Payer: Vantage Medical Group Senior |
$8.18
|
|
|
HC SOM CONTROLLED SUB MON 4
|
Facility
|
IP
|
$9.62
|
|
|
Service Code
|
CPT 80326
|
| Hospital Charge Code |
900915357
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$9.62
|
| Rate for Payer: Central Health Plan Commercial |
$7.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.85
|
| Rate for Payer: EPIC Health Plan Senior |
$3.85
|
| Rate for Payer: Galaxy Health WC |
$8.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.21
|
| Rate for Payer: Networks By Design Commercial |
$6.25
|
| Rate for Payer: Prime Health Services Commercial |
$8.18
|
|
|
HC SOM COPPER LIVER TISSUE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.83
|
| Rate for Payer: Blue Shield of California Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.65
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Riverside University Health System MISP |
$13.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER LIVER TISSUE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC SOM COPPER SERUM
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC SOM COPPER SERUM
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911099
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.83
|
| Rate for Payer: Blue Shield of California Commercial |
$9.45
|
| Rate for Payer: Blue Shield of California EPN |
$5.96
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.65
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Riverside University Health System MISP |
$13.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER URINE
|
Facility
|
OP
|
$39.97
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$125.83 |
| Rate for Payer: Adventist Health Commercial |
$7.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.83
|
| Rate for Payer: Blue Shield of California Commercial |
$25.18
|
| Rate for Payer: Blue Shield of California EPN |
$15.87
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Central Health Plan Commercial |
$31.98
|
| Rate for Payer: Cigna of CA HMO |
$25.58
|
| Rate for Payer: Cigna of CA PPO |
$29.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.48
|
| Rate for Payer: EPIC Health Plan Senior |
$13.65
|
| Rate for Payer: Galaxy Health WC |
$33.97
|
| Rate for Payer: Global Benefits Group Commercial |
$23.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.63
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
| Rate for Payer: Networks By Design Commercial |
$25.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.41
|
| Rate for Payer: Prime Health Services Commercial |
$33.97
|
| Rate for Payer: Prime Health Services Medicare |
$13.15
|
| Rate for Payer: Riverside University Health System MISP |
$13.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.05
|
| Rate for Payer: United Healthcare All Other HMO |
$10.05
|
| Rate for Payer: United Healthcare HMO Rider |
$10.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12.41
|
|
|
HC SOM COPPER URINE
|
Facility
|
IP
|
$39.97
|
|
|
Service Code
|
CPT 82525
|
| Hospital Charge Code |
900911134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$35.97 |
| Rate for Payer: Adventist Health Commercial |
$7.99
|
| Rate for Payer: Cash Price |
$39.97
|
| Rate for Payer: Central Health Plan Commercial |
$31.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.99
|
| Rate for Payer: EPIC Health Plan Senior |
$15.99
|
| Rate for Payer: Galaxy Health WC |
$33.97
|
| Rate for Payer: Global Benefits Group Commercial |
$23.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.99
|
| Rate for Payer: Multiplan Commercial |
$29.98
|
| Rate for Payer: Networks By Design Commercial |
$25.98
|
| Rate for Payer: Prime Health Services Commercial |
$33.97
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
OP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$12.58
|
| Rate for Payer: Blue Shield of California EPN |
$7.93
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Central Health Plan Commercial |
$15.98
|
| Rate for Payer: Cigna of CA HMO |
$12.78
|
| Rate for Payer: Cigna of CA PPO |
$14.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Networks By Design Commercial |
$12.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.11
|
| Rate for Payer: Prime Health Services Commercial |
$16.97
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Riverside University Health System MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM CORT FREE QUANTITATION
|
Facility
|
IP
|
$19.97
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$17.97 |
| Rate for Payer: Adventist Health Commercial |
$3.99
|
| Rate for Payer: Cash Price |
$19.97
|
| Rate for Payer: Central Health Plan Commercial |
$15.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.99
|
| Rate for Payer: EPIC Health Plan Senior |
$7.99
|
| Rate for Payer: Galaxy Health WC |
$16.97
|
| Rate for Payer: Global Benefits Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.78
|
| 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
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.91 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Central Health Plan Commercial |
$24.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.36
|
| Rate for Payer: Global Benefits Group Commercial |
$18.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.26
|
| Rate for Payer: Networks By Design Commercial |
$20.16
|
| Rate for Payer: Prime Health Services Commercial |
$26.36
|
|
|
HC SOM CORTISOL FREE RANDOM UR
|
Facility
|
OP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900912608
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$171.52 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.52
|
| Rate for Payer: Blue Shield of California Commercial |
$19.54
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Central Health Plan Commercial |
$24.81
|
| Rate for Payer: Cigna of CA HMO |
$19.85
|
| Rate for Payer: Cigna of CA PPO |
$22.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.57
|
| Rate for Payer: EPIC Health Plan Senior |
$18.38
|
| Rate for Payer: Galaxy Health WC |
$26.36
|
| Rate for Payer: Global Benefits Group Commercial |
$18.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$23.26
|
| Rate for Payer: Networks By Design Commercial |
$20.16
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.71
|
| Rate for Payer: Prime Health Services Commercial |
$26.36
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Riverside University Health System MISP |
$18.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
IP
|
$40.60
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$36.54 |
| Rate for Payer: Adventist Health Commercial |
$8.12
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Central Health Plan Commercial |
$32.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.24
|
| Rate for Payer: EPIC Health Plan Senior |
$16.24
|
| Rate for Payer: Galaxy Health WC |
$34.51
|
| Rate for Payer: Global Benefits Group Commercial |
$24.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$30.45
|
| Rate for Payer: Networks By Design Commercial |
$26.39
|
| Rate for Payer: Prime Health Services Commercial |
$34.51
|
|
|
HC SOM CORTISOL FREE SERUM
|
Facility
|
OP
|
$40.60
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900910672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$171.52 |
| Rate for Payer: Adventist Health Commercial |
$8.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.52
|
| Rate for Payer: Blue Shield of California Commercial |
$25.58
|
| Rate for Payer: Blue Shield of California EPN |
$16.12
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Central Health Plan Commercial |
$32.48
|
| Rate for Payer: Cigna of CA HMO |
$25.98
|
| Rate for Payer: Cigna of CA PPO |
$30.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.57
|
| Rate for Payer: EPIC Health Plan Senior |
$18.38
|
| Rate for Payer: Galaxy Health WC |
$34.51
|
| Rate for Payer: Global Benefits Group Commercial |
$24.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$30.45
|
| Rate for Payer: Networks By Design Commercial |
$26.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.71
|
| Rate for Payer: Prime Health Services Commercial |
$34.51
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Riverside University Health System MISP |
$18.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE UR
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| 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
|
|
