|
HC SOM FBIOT 84591
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
900914760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.44
|
| Rate for Payer: Blue Shield of California Commercial |
$66.90
|
| Rate for Payer: Blue Shield of California EPN |
$44.20
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.03
|
| Rate for Payer: EPIC Health Plan Senior |
$17.06
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.81
|
| Rate for Payer: United Healthcare All Other HMO |
$13.81
|
| Rate for Payer: United Healthcare HMO Rider |
$13.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.77
|
| Rate for Payer: Vantage Medical Group Senior |
$17.06
|
|
|
HC SOM FBIOT 84591
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
900914760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM FBP1 88273
|
Facility
|
OP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$1,876.81 |
| Rate for Payer: Adventist Health Commercial |
$16.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,876.81
|
| Rate for Payer: Blue Shield of California Commercial |
$56.77
|
| Rate for Payer: Blue Shield of California EPN |
$37.51
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cigna of CA HMO |
$54.31
|
| Rate for Payer: Cigna of CA PPO |
$62.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Senior |
$34.81
|
| Rate for Payer: Galaxy Health WC |
$72.13
|
| Rate for Payer: Global Benefits Group Commercial |
$50.92
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: Networks By Design Commercial |
$55.16
|
| Rate for Payer: Prime Health Services Commercial |
$72.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM FBP1 88273
|
Facility
|
IP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$72.13 |
| Rate for Payer: Adventist Health Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.94
|
| Rate for Payer: EPIC Health Plan Senior |
$33.94
|
| Rate for Payer: Galaxy Health WC |
$72.13
|
| Rate for Payer: Global Benefits Group Commercial |
$50.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Multiplan Commercial |
$67.89
|
| Rate for Payer: Networks By Design Commercial |
$55.16
|
| Rate for Payer: Prime Health Services Commercial |
$72.13
|
|
|
HC SOM FBP1 88291
|
Facility
|
OP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$47.60
|
| Rate for Payer: Blue Shield of California EPN |
$31.45
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cigna of CA HMO |
$45.54
|
| Rate for Payer: Cigna of CA PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$56.92
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.48
|
| Rate for Payer: Vantage Medical Group Senior |
$60.48
|
|
|
HC SOM FBP1 88291
|
Facility
|
IP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$44.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.08
|
| Rate for Payer: Multiplan Commercial |
$56.92
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
|
|
HC SOM FCFQN 86171
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC SOM FCFQN 86171
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$98.95 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.95
|
| Rate for Payer: Blue Shield of California Commercial |
$44.82
|
| Rate for Payer: Blue Shield of California EPN |
$29.61
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.51
|
| Rate for Payer: EPIC Health Plan Senior |
$10.01
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10.01
|
|
|
HC SOM FCTRC 87110
|
Facility
|
OP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$193.57 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.57
|
| Rate for Payer: Blue Shield of California Commercial |
$46.54
|
| Rate for Payer: Blue Shield of California EPN |
$30.75
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cigna of CA HMO |
$44.52
|
| Rate for Payer: Cigna of CA PPO |
$51.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$55.66
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.88
|
| Rate for Payer: United Healthcare All Other HMO |
$15.88
|
| Rate for Payer: United Healthcare HMO Rider |
$15.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Vantage Medical Group Senior |
$19.60
|
|
|
HC SOM FCTRC 87110
|
Facility
|
IP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$59.13 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.83
|
| Rate for Payer: EPIC Health Plan Senior |
$27.83
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.70
|
| Rate for Payer: Multiplan Commercial |
$55.66
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
|
|
HC SOM FCTRC 87140
|
Facility
|
IP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$16.84 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.84
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$15.85
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$16.84
|
|
|
HC SOM FCTRC 87140
|
Facility
|
OP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$55.13 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.13
|
| Rate for Payer: Blue Shield of California Commercial |
$13.25
|
| Rate for Payer: Blue Shield of California EPN |
$8.76
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cigna of CA HMO |
$12.68
|
| Rate for Payer: Cigna of CA PPO |
$14.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$16.84
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$15.85
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$16.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC SOM FDSAC 82657
|
Facility
|
IP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$143.58 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.57
|
| Rate for Payer: EPIC Health Plan Senior |
$67.57
|
| Rate for Payer: Galaxy Health WC |
$143.58
|
| Rate for Payer: Global Benefits Group Commercial |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.54
|
| Rate for Payer: Multiplan Commercial |
$135.14
|
| Rate for Payer: Networks By Design Commercial |
$109.80
|
| Rate for Payer: Prime Health Services Commercial |
$143.58
|
|
|
HC SOM FDSAC 82657
|
Facility
|
OP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$113.01
|
| Rate for Payer: Blue Shield of California EPN |
$74.66
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Cigna of CA HMO |
$108.11
|
| Rate for Payer: Cigna of CA PPO |
$125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$143.58
|
| Rate for Payer: Global Benefits Group Commercial |
$101.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$135.14
|
| Rate for Payer: Networks By Design Commercial |
$109.80
|
| Rate for Payer: Prime Health Services Commercial |
$143.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM FDXM 82542
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$85.85 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC SOM FDXM 82542
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$67.57
|
| Rate for Payer: Blue Shield of California EPN |
$44.64
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FEAGR 86682
|
Facility
|
IP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$44.68 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.03
|
| Rate for Payer: EPIC Health Plan Senior |
$21.03
|
| Rate for Payer: Galaxy Health WC |
$44.68
|
| Rate for Payer: Global Benefits Group Commercial |
$31.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.62
|
| Rate for Payer: Multiplan Commercial |
$42.06
|
| Rate for Payer: Networks By Design Commercial |
$34.17
|
| Rate for Payer: Prime Health Services Commercial |
$44.68
|
|
|
HC SOM FEAGR 86682
|
Facility
|
OP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$129.67 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.67
|
| Rate for Payer: Blue Shield of California Commercial |
$35.17
|
| Rate for Payer: Blue Shield of California EPN |
$23.24
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cigna of CA HMO |
$33.64
|
| Rate for Payer: Cigna of CA PPO |
$38.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.01
|
| Rate for Payer: Galaxy Health WC |
$44.68
|
| Rate for Payer: Global Benefits Group Commercial |
$31.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$42.06
|
| Rate for Payer: Networks By Design Commercial |
$34.17
|
| Rate for Payer: Prime Health Services Commercial |
$44.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM FELBAMATE S
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.47
|
| Rate for Payer: EPIC Health Plan Senior |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.08
|
| Rate for Payer: Multiplan Commercial |
$16.94
|
| Rate for Payer: Networks By Design Commercial |
$13.76
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC SOM FELBAMATE S
|
Facility
|
OP
|
$21.17
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$65.17 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.17
|
| Rate for Payer: Blue Shield of California Commercial |
$14.16
|
| Rate for Payer: Blue Shield of California EPN |
$9.36
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cigna of CA HMO |
$13.55
|
| Rate for Payer: Cigna of CA PPO |
$15.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$16.94
|
| Rate for Payer: Networks By Design Commercial |
$13.76
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM FENTU
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM FENTU
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$184.33 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.33
|
| Rate for Payer: Blue Shield of California Commercial |
$30.11
|
| Rate for Payer: Blue Shield of California EPN |
$19.89
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM FESC 83789
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$177.61 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.61
|
| Rate for Payer: Blue Shield of California Commercial |
$90.98
|
| Rate for Payer: Blue Shield of California EPN |
$60.11
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: EPIC Health Plan Senior |
$24.11
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM FESC 83789
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC SOM FFTP 86780
|
Facility
|
OP
|
$28.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914768
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.36
|
| Rate for Payer: Blue Shield of California Commercial |
$19.13
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$18.30
|
| Rate for Payer: Cigna of CA PPO |
$21.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$24.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$22.88
|
| Rate for Payer: Networks By Design Commercial |
$18.59
|
| Rate for Payer: Prime Health Services Commercial |
$24.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
