|
HC SOM CELIAC COMP IGA
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
900914382
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Adventist Health Commercial |
$1.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4.34
|
| Rate for Payer: Blue Shield of California EPN |
$2.86
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cigna of CA HMO |
$4.15
|
| Rate for Payer: Cigna of CA PPO |
$4.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.55
|
| Rate for Payer: EPIC Health Plan Senior |
$9.30
|
| Rate for Payer: Galaxy Health WC |
$5.51
|
| Rate for Payer: Global Benefits Group Commercial |
$3.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$5.18
|
| Rate for Payer: Networks By Design Commercial |
$4.21
|
| Rate for Payer: Prime Health Services Commercial |
$5.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.53
|
| Rate for Payer: United Healthcare All Other HMO |
$7.53
|
| Rate for Payer: United Healthcare HMO Rider |
$7.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.23
|
| Rate for Payer: Vantage Medical Group Senior |
$9.30
|
|
|
HC SOM CERULOPLASMIN
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM CERULOPLASMIN
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$106.06 |
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.06
|
| Rate for Payer: Blue Shield of California Commercial |
$8.03
|
| Rate for Payer: Blue Shield of California EPN |
$5.30
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.98
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
IP
|
$290.10
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$246.59 |
| Rate for Payer: Adventist Health Commercial |
$58.02
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.04
|
| Rate for Payer: EPIC Health Plan Senior |
$116.04
|
| Rate for Payer: Galaxy Health WC |
$246.59
|
| Rate for Payer: Global Benefits Group Commercial |
$174.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.62
|
| Rate for Payer: Multiplan Commercial |
$232.08
|
| Rate for Payer: Networks By Design Commercial |
$188.56
|
| Rate for Payer: Prime Health Services Commercial |
$246.59
|
|
|
HC SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
OP
|
$290.10
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$246.59 |
| Rate for Payer: Adventist Health Commercial |
$58.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.22
|
| Rate for Payer: Blue Shield of California Commercial |
$194.08
|
| Rate for Payer: Blue Shield of California EPN |
$128.22
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna of CA HMO |
$185.66
|
| Rate for Payer: Cigna of CA PPO |
$214.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.04
|
| Rate for Payer: EPIC Health Plan Senior |
$116.04
|
| Rate for Payer: Galaxy Health WC |
$246.59
|
| Rate for Payer: Global Benefits Group Commercial |
$174.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.07
|
| Rate for Payer: Multiplan Commercial |
$232.08
|
| Rate for Payer: Networks By Design Commercial |
$188.56
|
| Rate for Payer: Prime Health Services Commercial |
$246.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.05
|
| Rate for Payer: United Healthcare HMO Rider |
$145.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.59
|
| Rate for Payer: Vantage Medical Group Senior |
$246.59
|
|
|
HC SOM CHLORIDE BF
|
Facility
|
OP
|
$7.01
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900914683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$48.28 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4.69
|
| Rate for Payer: Blue Shield of California EPN |
$3.10
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cigna of CA HMO |
$4.49
|
| Rate for Payer: Cigna of CA PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Senior |
$5.00
|
| Rate for Payer: Galaxy Health WC |
$5.96
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.61
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
|
|
HC SOM CHLORIDE BF
|
Facility
|
IP
|
$7.01
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900914683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.96 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.96
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.61
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.96
|
|
|
HC SOM CHOLESTEROL BF
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.09
|
| Rate for Payer: Blue Shield of California Commercial |
$110.39
|
| Rate for Payer: Blue Shield of California EPN |
$72.93
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM CHOLESTEROL BF
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
OP
|
$116.50
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$99.03 |
| Rate for Payer: Adventist Health Commercial |
$23.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.80
|
| Rate for Payer: Blue Shield of California Commercial |
$77.94
|
| Rate for Payer: Blue Shield of California EPN |
$51.49
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cigna of CA HMO |
$74.56
|
| Rate for Payer: Cigna of CA PPO |
$86.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$99.03
|
| Rate for Payer: Global Benefits Group Commercial |
$69.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$93.20
|
| Rate for Payer: Networks By Design Commercial |
$75.72
|
| Rate for Payer: Prime Health Services Commercial |
$99.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO |
$6.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Vantage Medical Group Senior |
$7.87
|
|
|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
IP
|
$116.50
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$99.03 |
| Rate for Payer: Adventist Health Commercial |
$23.30
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.60
|
| Rate for Payer: EPIC Health Plan Senior |
$46.60
|
| Rate for Payer: Galaxy Health WC |
$99.03
|
| Rate for Payer: Global Benefits Group Commercial |
$69.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.96
|
| Rate for Payer: Multiplan Commercial |
$93.20
|
| Rate for Payer: Networks By Design Commercial |
$75.72
|
| Rate for Payer: Prime Health Services Commercial |
$99.03
|
|
|
HC SOM CHRAF CULTURE 03
|
Facility
|
IP
|
$137.52
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$116.89 |
| Rate for Payer: Adventist Health Commercial |
$27.50
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.01
|
| Rate for Payer: EPIC Health Plan Senior |
$55.01
|
| Rate for Payer: Galaxy Health WC |
$116.89
|
| Rate for Payer: Global Benefits Group Commercial |
$82.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$110.02
|
| Rate for Payer: Networks By Design Commercial |
$89.39
|
| Rate for Payer: Prime Health Services Commercial |
$116.89
|
|
|
HC SOM CHRAF CULTURE 03
|
Facility
|
OP
|
$137.52
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: Adventist Health Commercial |
$27.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.55
|
| Rate for Payer: Blue Shield of California Commercial |
$92.00
|
| Rate for Payer: Blue Shield of California EPN |
$60.78
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Cigna of CA HMO |
$88.01
|
| Rate for Payer: Cigna of CA PPO |
$101.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$116.89
|
| Rate for Payer: Global Benefits Group Commercial |
$82.51
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$110.02
|
| Rate for Payer: Networks By Design Commercial |
$89.39
|
| Rate for Payer: Prime Health Services Commercial |
$116.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRBM CULTURE 04
|
Facility
|
OP
|
$101.87
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: Adventist Health Commercial |
$20.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.10
|
| Rate for Payer: Blue Shield of California Commercial |
$68.15
|
| Rate for Payer: Blue Shield of California EPN |
$45.03
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Cigna of CA HMO |
$65.20
|
| Rate for Payer: Cigna of CA PPO |
$75.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Senior |
$143.75
|
| Rate for Payer: Galaxy Health WC |
$86.59
|
| Rate for Payer: Global Benefits Group Commercial |
$61.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$81.50
|
| Rate for Payer: Networks By Design Commercial |
$66.22
|
| Rate for Payer: Prime Health Services Commercial |
$86.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRBM CULTURE 04
|
Facility
|
IP
|
$101.87
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$86.59 |
| Rate for Payer: Adventist Health Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.75
|
| Rate for Payer: EPIC Health Plan Senior |
$40.75
|
| Rate for Payer: Galaxy Health WC |
$86.59
|
| Rate for Payer: Global Benefits Group Commercial |
$61.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.45
|
| Rate for Payer: Multiplan Commercial |
$81.50
|
| Rate for Payer: Networks By Design Commercial |
$66.22
|
| Rate for Payer: Prime Health Services Commercial |
$86.59
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
|
IP
|
$89.11
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$75.74 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.39
|
| Rate for Payer: Multiplan Commercial |
$71.29
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
|
OP
|
$89.11
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$976.91 |
| Rate for Payer: EPIC Health Plan Senior |
$116.49
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$976.91
|
| Rate for Payer: Blue Shield of California Commercial |
$59.61
|
| Rate for Payer: Blue Shield of California EPN |
$39.39
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cigna of CA HMO |
$57.03
|
| Rate for Payer: Cigna of CA PPO |
$65.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.26
|
| Rate for Payer: Global Benefits Group Commercial |
$53.47
|
| Rate for Payer: Heritage Provider Network Commercial |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$146.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$71.29
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
|
IP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$301.32 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.80
|
| Rate for Payer: EPIC Health Plan Senior |
$141.80
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.08
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
|
OP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$1,090.55 |
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,090.55
|
| Rate for Payer: Blue Shield of California Commercial |
$237.16
|
| Rate for Payer: Blue Shield of California EPN |
$156.69
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cigna of CA HMO |
$226.88
|
| Rate for Payer: Cigna of CA PPO |
$262.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$189.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$283.60
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
IP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$135.42 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.73
|
| Rate for Payer: EPIC Health Plan Senior |
$63.73
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.24
|
| Rate for Payer: Multiplan Commercial |
$127.46
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
OP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$1,059.10 |
| Rate for Payer: EPIC Health Plan Senior |
$143.75
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.10
|
| Rate for Payer: Blue Shield of California Commercial |
$106.59
|
| Rate for Payer: Blue Shield of California EPN |
$70.42
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Cigna of CA HMO |
$101.96
|
| Rate for Payer: Cigna of CA PPO |
$117.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$127.46
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
OP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.00
|
| Rate for Payer: Blue Shield of California Commercial |
$119.38
|
| Rate for Payer: Blue Shield of California EPN |
$78.87
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Cigna of CA HMO |
$114.20
|
| Rate for Payer: Cigna of CA PPO |
$132.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$220.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$142.75
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
IP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$151.67 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.38
|
| Rate for Payer: EPIC Health Plan Senior |
$71.38
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.83
|
| Rate for Payer: Multiplan Commercial |
$142.75
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
|
