|
HC SOM FHTL 87798A
|
Facility
|
OP
|
$112.81
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$75.47
|
| Rate for Payer: Blue Shield of California EPN |
$49.86
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Cigna of CA HMO |
$72.20
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$95.89
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$90.25
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: Prime Health Services Commercial |
$95.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM FHTL 87798B
|
Facility
|
IP
|
$112.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$95.90 |
| Rate for Payer: Galaxy Health WC |
$95.90
|
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.13
|
| Rate for Payer: EPIC Health Plan Senior |
$45.13
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.08
|
| Rate for Payer: Multiplan Commercial |
$90.26
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: Prime Health Services Commercial |
$95.90
|
|
|
HC SOM FHTL 87798B
|
Facility
|
OP
|
$112.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$75.48
|
| Rate for Payer: Blue Shield of California EPN |
$49.87
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cigna of CA HMO |
$72.20
|
| Rate for Payer: Cigna of CA PPO |
$83.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$95.90
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$90.26
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: Prime Health Services Commercial |
$95.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM FIAIA 82397
|
Facility
|
IP
|
$186.25
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$158.31 |
| Rate for Payer: Adventist Health Commercial |
$37.25
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.50
|
| Rate for Payer: EPIC Health Plan Senior |
$74.50
|
| Rate for Payer: Galaxy Health WC |
$158.31
|
| Rate for Payer: Global Benefits Group Commercial |
$111.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.70
|
| Rate for Payer: Multiplan Commercial |
$149.00
|
| Rate for Payer: Networks By Design Commercial |
$121.06
|
| Rate for Payer: Prime Health Services Commercial |
$158.31
|
|
|
HC SOM FIAIA 82397
|
Facility
|
OP
|
$186.25
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$158.31 |
| Rate for Payer: EPIC Health Plan Senior |
$14.12
|
| Rate for Payer: Galaxy Health WC |
$158.31
|
| Rate for Payer: Adventist Health Commercial |
$37.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.58
|
| Rate for Payer: Blue Shield of California Commercial |
$124.60
|
| Rate for Payer: Blue Shield of California EPN |
$82.32
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Cigna of CA HMO |
$119.20
|
| Rate for Payer: Cigna of CA PPO |
$137.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: Global Benefits Group Commercial |
$111.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$149.00
|
| Rate for Payer: Networks By Design Commercial |
$121.06
|
| Rate for Payer: Prime Health Services Commercial |
$158.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
|
IP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$165.31 |
| Rate for Payer: Adventist Health Commercial |
$38.90
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.79
|
| Rate for Payer: EPIC Health Plan Senior |
$77.79
|
| Rate for Payer: Galaxy Health WC |
$165.31
|
| Rate for Payer: Global Benefits Group Commercial |
$116.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.68
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Networks By Design Commercial |
$126.41
|
| Rate for Payer: Prime Health Services Commercial |
$165.31
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
|
OP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$1,179.99 |
| Rate for Payer: EPIC Health Plan Senior |
$140.73
|
| Rate for Payer: Galaxy Health WC |
$165.31
|
| Rate for Payer: Adventist Health Commercial |
$38.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,179.99
|
| Rate for Payer: Blue Shield of California Commercial |
$130.11
|
| Rate for Payer: Blue Shield of California EPN |
$85.96
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Cigna of CA HMO |
$124.47
|
| Rate for Payer: Cigna of CA PPO |
$143.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.99
|
| Rate for Payer: Global Benefits Group Commercial |
$116.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$210.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Networks By Design Commercial |
$126.41
|
| Rate for Payer: Prime Health Services Commercial |
$165.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: EPIC Health Plan Senior |
$13.07
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.33
|
| Rate for Payer: Blue Shield of California EPN |
$6.17
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$8.93
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.64
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$11.16
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$11.86 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: EPIC Health Plan Senior |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.35
|
| Rate for Payer: Multiplan Commercial |
$11.16
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
|
|
HC SOM FIDQL 86331
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$118.36 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.36
|
| Rate for Payer: Blue Shield of California Commercial |
$39.47
|
| Rate for Payer: Blue Shield of California EPN |
$26.08
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM FIDQL 86331
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC SOM FINA 86382
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: EPIC Health Plan Senior |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.32
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC SOM FINA 86382
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$334.05 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.23
|
| Rate for Payer: Blue Shield of California Commercial |
$262.92
|
| Rate for Payer: Blue Shield of California EPN |
$173.71
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.83
|
| Rate for Payer: EPIC Health Plan Senior |
$16.91
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.66
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.70
|
| Rate for Payer: United Healthcare All Other HMO |
$13.70
|
| Rate for Payer: United Healthcare HMO Rider |
$13.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: Vantage Medical Group Senior |
$16.91
|
|
|
HC SOM FINA 87253
|
Facility
|
OP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$398.85 |
| Rate for Payer: Adventist Health Commercial |
$93.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$307.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.85
|
| Rate for Payer: Blue Shield of California Commercial |
$313.91
|
| Rate for Payer: Blue Shield of California EPN |
$207.40
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Cigna of CA HMO |
$300.31
|
| Rate for Payer: Cigna of CA PPO |
$347.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.27
|
| Rate for Payer: EPIC Health Plan Senior |
$20.20
|
| Rate for Payer: Galaxy Health WC |
$398.85
|
| Rate for Payer: Global Benefits Group Commercial |
$281.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.07
|
| Rate for Payer: Multiplan Commercial |
$375.38
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$398.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.36
|
| Rate for Payer: United Healthcare All Other HMO |
$16.36
|
| Rate for Payer: United Healthcare HMO Rider |
$16.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: Vantage Medical Group Senior |
$20.20
|
|
|
HC SOM FINA 87253
|
Facility
|
IP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$93.85 |
| Max. Negotiated Rate |
$398.85 |
| Rate for Payer: Adventist Health Commercial |
$93.85
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.69
|
| Rate for Payer: EPIC Health Plan Senior |
$187.69
|
| Rate for Payer: Galaxy Health WC |
$398.85
|
| Rate for Payer: Global Benefits Group Commercial |
$281.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.62
|
| Rate for Payer: Multiplan Commercial |
$375.38
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$398.85
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$234.15
|
| Rate for Payer: Blue Shield of California EPN |
$154.70
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| 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 |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FISH B ALL
|
Facility
|
IP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: EPIC Health Plan Senior |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.75
|
| Rate for Payer: Global Benefits Group Commercial |
$102.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.87
|
| Rate for Payer: Multiplan Commercial |
$136.24
|
| Rate for Payer: Networks By Design Commercial |
$110.69
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
|
|
HC SOM FISH B ALL
|
Facility
|
OP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$113.93
|
| Rate for Payer: Blue Shield of California EPN |
$75.27
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cigna of CA HMO |
$108.99
|
| Rate for Payer: Cigna of CA PPO |
$126.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: EPIC Health Plan Senior |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.75
|
| Rate for Payer: Global Benefits Group Commercial |
$102.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$119.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$136.24
|
| Rate for Payer: Networks By Design Commercial |
$110.69
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.18
|
| 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 |
$144.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.75
|
| Rate for Payer: Vantage Medical Group Senior |
$144.75
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$133.80
|
| Rate for Payer: Blue Shield of California EPN |
$88.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| 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 |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$170.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$234.15
|
| Rate for Payer: Blue Shield of California EPN |
$154.70
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| 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 |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM FISH MDS LOCUS ANOMALIES
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912610
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$184.53 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.53
|
| Rate for Payer: Blue Shield of California Commercial |
$100.35
|
| Rate for Payer: Blue Shield of California EPN |
$66.30
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
