|
HC SOM CORTISOL FREE UR
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900914673
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$171.52 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$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 |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.57
|
| Rate for Payer: EPIC Health Plan Senior |
$18.38
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| 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 |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.39
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.71
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.71
|
| Rate for Payer: Riverside University Health System MISP |
$18.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.54
|
| Rate for Payer: United Healthcare All Other HMO |
$13.54
|
| Rate for Payer: United Healthcare HMO Rider |
$13.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.71
|
|
|
HC SOM CORTISOL FREE URINE
|
Facility
|
IP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
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 URINE
|
Facility
|
OP
|
$31.01
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
900911026
|
|
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 COUMADIN LEVEL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC SOM COUMADIN LEVEL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
900911161
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$174.79 |
| Rate for Payer: Adventist Health Commercial |
$21.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$59.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$81.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.79
|
| Rate for Payer: Blue Shield of California Commercial |
$68.67
|
| Rate for Payer: Blue Shield of California EPN |
$43.27
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: Cigna of CA HMO |
$69.76
|
| Rate for Payer: Cigna of CA PPO |
$80.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$76.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: EPIC Health Plan Senior |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
| Rate for Payer: Riverside University Health System MISP |
$43.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.50
|
| Rate for Payer: United Healthcare All Other HMO |
$54.50
|
| Rate for Payer: United Healthcare HMO Rider |
$54.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$54.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.65
|
| Rate for Payer: Vantage Medical Group Senior |
$92.65
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
IP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.02 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.01
|
| Rate for Payer: EPIC Health Plan Senior |
$4.01
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
|
|
HC SOM COXIELLA BURNETTI AB PANEL
|
Facility
|
OP
|
$10.02
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
900911769
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$127.67 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$91.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.67
|
| Rate for Payer: Blue Shield of California Commercial |
$6.31
|
| Rate for Payer: Blue Shield of California EPN |
$3.98
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Central Health Plan Commercial |
$8.02
|
| Rate for Payer: Cigna of CA HMO |
$6.41
|
| Rate for Payer: Cigna of CA PPO |
$7.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13.33
|
| Rate for Payer: Galaxy Health WC |
$8.52
|
| Rate for Payer: Global Benefits Group Commercial |
$6.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.24
|
| Rate for Payer: Multiplan Commercial |
$7.51
|
| Rate for Payer: Networks By Design Commercial |
$6.51
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.12
|
| Rate for Payer: Prime Health Services Commercial |
$8.52
|
| Rate for Payer: Prime Health Services Medicare |
$12.85
|
| Rate for Payer: Riverside University Health System MISP |
$13.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.82
|
| Rate for Payer: United Healthcare All Other HMO |
$9.82
|
| Rate for Payer: United Healthcare HMO Rider |
$9.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.33
|
| Rate for Payer: Vantage Medical Group Senior |
$12.12
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM C-PEPTIDE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
900911116
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$171.52 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22.89
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$34.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.89
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.81
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$22.06
|
| Rate for Payer: Riverside University Health System MISP |
$22.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.86
|
| Rate for Payer: United Healthcare All Other HMO |
$16.86
|
| Rate for Payer: United Healthcare HMO Rider |
$16.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.89
|
| Rate for Payer: Vantage Medical Group Senior |
$20.81
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$13.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
|
|
HC SOM C PNEUMONIA IGG
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900911125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.53
|
| Rate for Payer: Blue Shield of California Commercial |
$10.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.61
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$13.31
|
| Rate for Payer: Cigna of CA HMO |
$10.65
|
| Rate for Payer: Cigna of CA PPO |
$12.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.00
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
| Rate for Payer: Prime Health Services Medicare |
$12.53
|
| Rate for Payer: Riverside University Health System MISP |
$13.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO |
$9.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
OP
|
$17.85
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.53
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$7.09
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Central Health Plan Commercial |
$14.28
|
| Rate for Payer: Cigna of CA HMO |
$11.42
|
| Rate for Payer: Cigna of CA PPO |
$13.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Senior |
$13.95
|
| Rate for Payer: Galaxy Health WC |
$15.17
|
| Rate for Payer: Global Benefits Group Commercial |
$10.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: Networks By Design Commercial |
$11.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$15.17
|
| Rate for Payer: Prime Health Services Medicare |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$13.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM C. PNEUMONIA IGM
|
Facility
|
IP
|
$17.85
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912797
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Central Health Plan Commercial |
$14.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: EPIC Health Plan Senior |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$15.17
|
| Rate for Payer: Global Benefits Group Commercial |
$10.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: Networks By Design Commercial |
$11.60
|
| Rate for Payer: Prime Health Services Commercial |
$15.17
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
OP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$86.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.53
|
| Rate for Payer: Blue Shield of California Commercial |
$10.48
|
| Rate for Payer: Blue Shield of California EPN |
$6.61
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$13.31
|
| Rate for Payer: Cigna of CA HMO |
$10.65
|
| Rate for Payer: Cigna of CA PPO |
$12.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.50
|
| Rate for Payer: EPIC Health Plan Senior |
$13.00
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.98
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
| Rate for Payer: Prime Health Services Medicare |
$12.53
|
| Rate for Payer: Riverside University Health System MISP |
$13.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.58
|
| Rate for Payer: United Healthcare All Other HMO |
$9.58
|
| Rate for Payer: United Healthcare HMO Rider |
$9.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.00
|
| Rate for Payer: Vantage Medical Group Senior |
$11.82
|
|
|
HC SOM C. PSITTACI IGG
|
Facility
|
IP
|
$16.64
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
900912800
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$13.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.66
|
| Rate for Payer: EPIC Health Plan Senior |
$6.66
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$12.48
|
| Rate for Payer: Networks By Design Commercial |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
IP
|
$17.86
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$16.07 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Central Health Plan Commercial |
$14.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.14
|
| Rate for Payer: EPIC Health Plan Senior |
$7.14
|
| Rate for Payer: Galaxy Health WC |
$15.18
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: Networks By Design Commercial |
$11.61
|
| Rate for Payer: Prime Health Services Commercial |
$15.18
|
|
|
HC SOM C. PSITTACI IGM
|
Facility
|
OP
|
$17.86
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
900912798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Adventist Health Commercial |
$3.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.53
|
| Rate for Payer: Blue Shield of California Commercial |
$11.25
|
| Rate for Payer: Blue Shield of California EPN |
$7.09
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Central Health Plan Commercial |
$14.29
|
| Rate for Payer: Cigna of CA HMO |
$11.43
|
| Rate for Payer: Cigna of CA PPO |
$13.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.92
|
| Rate for Payer: EPIC Health Plan Senior |
$13.95
|
| Rate for Payer: Galaxy Health WC |
$15.18
|
| Rate for Payer: Global Benefits Group Commercial |
$10.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$20.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.99
|
| Rate for Payer: Multiplan Commercial |
$13.39
|
| Rate for Payer: Networks By Design Commercial |
$11.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.68
|
| Rate for Payer: Prime Health Services Commercial |
$15.18
|
| Rate for Payer: Prime Health Services Medicare |
$13.44
|
| Rate for Payer: Riverside University Health System MISP |
$13.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Other HMO |
$10.27
|
| Rate for Payer: United Healthcare HMO Rider |
$10.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.68
|
|
|
HC SOM CREATININE RANDOM, U
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
|
|
HC SOM CREATININE RANDOM, U
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900915438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$52.29 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3.67
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$4.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
OP
|
$16.69
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$86.75 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.75
|
| Rate for Payer: Blue Shield of California Commercial |
$10.51
|
| Rate for Payer: Blue Shield of California EPN |
$6.63
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Central Health Plan Commercial |
$13.35
|
| Rate for Payer: Cigna of CA HMO |
$10.68
|
| Rate for Payer: Cigna of CA PPO |
$12.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.33
|
| Rate for Payer: EPIC Health Plan Senior |
$15.55
|
| Rate for Payer: Galaxy Health WC |
$14.19
|
| Rate for Payer: Global Benefits Group Commercial |
$10.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$12.52
|
| Rate for Payer: Networks By Design Commercial |
$10.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.14
|
| Rate for Payer: Prime Health Services Commercial |
$14.19
|
| Rate for Payer: Prime Health Services Medicare |
$14.99
|
| Rate for Payer: Riverside University Health System MISP |
$15.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Other HMO |
$11.46
|
| Rate for Payer: United Healthcare HMO Rider |
$11.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.55
|
| Rate for Payer: Vantage Medical Group Senior |
$14.14
|
|
|
HC SOM CRYOFIBRINOGEN
|
Facility
|
IP
|
$16.69
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
900911373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Adventist Health Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Central Health Plan Commercial |
$13.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.68
|
| Rate for Payer: EPIC Health Plan Senior |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$14.19
|
| Rate for Payer: Global Benefits Group Commercial |
$10.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
| Rate for Payer: Multiplan Commercial |
$12.52
|
| Rate for Payer: Networks By Design Commercial |
$10.85
|
| Rate for Payer: Prime Health Services Commercial |
$14.19
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3.05
|
| Rate for Payer: Galaxy Health WC |
$6.49
|
| Rate for Payer: Global Benefits Group Commercial |
$4.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: Prime Health Services Commercial |
$6.49
|
|
|
HC SOM CRYOFIBRINOGEN CRYOGLOBULIN
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
900912819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$63.73 |
| Rate for Payer: Adventist Health Commercial |
$1.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.73
|
| Rate for Payer: Blue Shield of California Commercial |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.03
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Cash Price |
$7.63
|
| Rate for Payer: Central Health Plan Commercial |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$4.88
|
| Rate for Payer: Cigna of CA PPO |
$5.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$6.49
|
| Rate for Payer: Global Benefits Group Commercial |
$4.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$5.72
|
| Rate for Payer: Networks By Design Commercial |
$4.96
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$6.49
|
| Rate for Payer: Prime Health Services Medicare |
$6.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Blue Shield of California Commercial |
$25.20
|
| Rate for Payer: Blue Shield of California EPN |
$15.88
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.82
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.65
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.20
|
| Rate for Payer: United Healthcare All Other HMO |
$11.20
|
| Rate for Payer: United Healthcare HMO Rider |
$11.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13.82
|
|
|
HC SOM CRYPTOSPORIDIUM AG, F
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
900912939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
