|
HC SOM MGLES 83519C
|
Facility
|
IP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$107.45 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.45
|
| Rate for Payer: Global Benefits Group Commercial |
$75.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$101.13
|
| Rate for Payer: Networks By Design Commercial |
$82.17
|
| Rate for Payer: Prime Health Services Commercial |
$107.45
|
|
|
HC SOM MGLES 83519D
|
Facility
|
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$107.44 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: EPIC Health Plan Senior |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Multiplan Commercial |
$101.12
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83519D
|
Facility
|
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$133.46 |
| Rate for Payer: Adventist Health Commercial |
$25.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.46
|
| Rate for Payer: Blue Shield of California Commercial |
$84.56
|
| Rate for Payer: Blue Shield of California EPN |
$55.87
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Senior |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$101.12
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83520
|
Facility
|
OP
|
$121.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$127.87 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.87
|
| Rate for Payer: Blue Shield of California Commercial |
$81.06
|
| Rate for Payer: Blue Shield of California EPN |
$53.56
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cigna of CA HMO |
$77.55
|
| Rate for Payer: Cigna of CA PPO |
$89.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Senior |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$102.99
|
| Rate for Payer: Global Benefits Group Commercial |
$72.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$96.94
|
| Rate for Payer: Networks By Design Commercial |
$78.76
|
| Rate for Payer: Prime Health Services Commercial |
$102.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM MGLES 83520
|
Facility
|
IP
|
$121.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$102.99 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.47
|
| Rate for Payer: EPIC Health Plan Senior |
$48.47
|
| Rate for Payer: Galaxy Health WC |
$102.99
|
| Rate for Payer: Global Benefits Group Commercial |
$72.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.08
|
| Rate for Payer: Multiplan Commercial |
$96.94
|
| Rate for Payer: Networks By Design Commercial |
$78.76
|
| Rate for Payer: Prime Health Services Commercial |
$102.99
|
|
|
HC SOM MICROSPORIDIA CULTURE
|
Facility
|
OP
|
$206.40
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900912827
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$175.44 |
| Rate for Payer: Adventist Health Commercial |
$41.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.97
|
| Rate for Payer: Blue Shield of California Commercial |
$138.08
|
| Rate for Payer: Blue Shield of California EPN |
$91.23
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cigna of CA HMO |
$132.10
|
| Rate for Payer: Cigna of CA PPO |
$152.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$175.44
|
| Rate for Payer: Global Benefits Group Commercial |
$123.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$165.12
|
| Rate for Payer: Networks By Design Commercial |
$134.16
|
| Rate for Payer: Prime Health Services Commercial |
$175.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC SOM MICROSPORIDIA CULTURE
|
Facility
|
IP
|
$206.40
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900912827
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$175.44 |
| Rate for Payer: Adventist Health Commercial |
$41.28
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.56
|
| Rate for Payer: EPIC Health Plan Senior |
$82.56
|
| Rate for Payer: Galaxy Health WC |
$175.44
|
| Rate for Payer: Global Benefits Group Commercial |
$123.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.54
|
| Rate for Payer: Multiplan Commercial |
$165.12
|
| Rate for Payer: Networks By Design Commercial |
$134.16
|
| Rate for Payer: Prime Health Services Commercial |
$175.44
|
|
|
HC SOM MICROSPORIDIA DETECTION
|
Facility
|
OP
|
$89.72
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911588
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$76.26 |
| Rate for Payer: Adventist Health Commercial |
$17.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.18
|
| Rate for Payer: Blue Shield of California Commercial |
$60.02
|
| Rate for Payer: Blue Shield of California EPN |
$39.66
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: Cigna of CA HMO |
$57.42
|
| Rate for Payer: Cigna of CA PPO |
$66.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Senior |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$76.26
|
| Rate for Payer: Global Benefits Group Commercial |
$53.83
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$71.78
|
| Rate for Payer: Networks By Design Commercial |
$58.32
|
| Rate for Payer: Prime Health Services Commercial |
$76.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC SOM MICROSPORIDIA DETECTION
|
Facility
|
IP
|
$89.72
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911588
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$76.26 |
| Rate for Payer: Adventist Health Commercial |
$17.94
|
| Rate for Payer: Cash Price |
$89.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.89
|
| Rate for Payer: EPIC Health Plan Senior |
$35.89
|
| Rate for Payer: Galaxy Health WC |
$76.26
|
| Rate for Payer: Global Benefits Group Commercial |
$53.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$71.78
|
| Rate for Payer: Networks By Design Commercial |
$58.32
|
| Rate for Payer: Prime Health Services Commercial |
$76.26
|
|
|
HC SOM MILK PROCESSED IGE
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$3.18
|
| Rate for Payer: Blue Shield of California EPN |
$2.10
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM MILK PROCESSED IGE
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.80
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
|
|
HC SOM MIRA VISTA HC HISTOPLASMA AG
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
900913883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$93.66
|
| Rate for Payer: Blue Shield of California EPN |
$61.88
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Senior |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.75
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.57
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM MIRA VISTA HC HISTOPLASMA AG
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
900913883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$119.00 |
| Rate for Payer: Adventist Health Commercial |
$28.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Senior |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC SOM MITOCHONDRIAL ANTIBO
|
Facility
|
OP
|
$10.82
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
900911178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$100.41 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.41
|
| Rate for Payer: Blue Shield of California Commercial |
$7.24
|
| Rate for Payer: Blue Shield of California EPN |
$4.78
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Cigna of CA HMO |
$6.92
|
| Rate for Payer: Cigna of CA PPO |
$8.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Senior |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$8.66
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM MITOCHONDRIAL ANTIBO
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
900911178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Adventist Health Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Senior |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$8.66
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
|
|
HC SOM MMRV 86735
|
Facility
|
IP
|
$100.43
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900914957
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Cash Price |
$100.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.17
|
| Rate for Payer: EPIC Health Plan Senior |
$40.17
|
| Rate for Payer: Galaxy Health WC |
$85.37
|
| Rate for Payer: Global Benefits Group Commercial |
$60.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.10
|
| Rate for Payer: Multiplan Commercial |
$80.34
|
| Rate for Payer: Networks By Design Commercial |
$65.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.37
|
|
|
HC SOM MMRV 86735
|
Facility
|
OP
|
$100.43
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900914957
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: EPIC Health Plan Senior |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$85.37
|
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$67.19
|
| Rate for Payer: Blue Shield of California EPN |
$44.39
|
| Rate for Payer: Cash Price |
$100.43
|
| Rate for Payer: Cash Price |
$100.43
|
| Rate for Payer: Cigna of CA HMO |
$64.28
|
| Rate for Payer: Cigna of CA PPO |
$74.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: Global Benefits Group Commercial |
$60.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$80.34
|
| Rate for Payer: Networks By Design Commercial |
$65.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO |
$10.57
|
| Rate for Payer: United Healthcare HMO Rider |
$10.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC SOM MMRV 86762
|
Facility
|
IP
|
$70.05
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900914958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Cash Price |
$70.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.02
|
| Rate for Payer: EPIC Health Plan Senior |
$28.02
|
| Rate for Payer: Galaxy Health WC |
$59.54
|
| Rate for Payer: Global Benefits Group Commercial |
$42.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$56.04
|
| Rate for Payer: Networks By Design Commercial |
$45.53
|
| Rate for Payer: Prime Health Services Commercial |
$59.54
|
|
|
HC SOM MMRV 86762
|
Facility
|
OP
|
$70.05
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900914958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Adventist Health Commercial |
$14.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.71
|
| Rate for Payer: Blue Shield of California Commercial |
$46.86
|
| Rate for Payer: Blue Shield of California EPN |
$30.96
|
| Rate for Payer: Cash Price |
$70.05
|
| Rate for Payer: Cash Price |
$70.05
|
| Rate for Payer: Cigna of CA HMO |
$44.83
|
| Rate for Payer: Cigna of CA PPO |
$51.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Senior |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$59.54
|
| Rate for Payer: Global Benefits Group Commercial |
$42.03
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$56.04
|
| Rate for Payer: Networks By Design Commercial |
$45.53
|
| Rate for Payer: Prime Health Services Commercial |
$59.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.65
|
| Rate for Payer: United Healthcare All Other HMO |
$11.65
|
| Rate for Payer: United Healthcare HMO Rider |
$11.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM MMRV 86765
|
Facility
|
IP
|
$17.90
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900914956
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$15.21 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.16
|
| Rate for Payer: EPIC Health Plan Senior |
$7.16
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
|
|
HC SOM MMRV 86765
|
Facility
|
OP
|
$17.90
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900914956
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Adventist Health Commercial |
$3.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$11.98
|
| Rate for Payer: Blue Shield of California EPN |
$7.91
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna of CA HMO |
$11.46
|
| Rate for Payer: Cigna of CA PPO |
$13.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$15.21
|
| Rate for Payer: Global Benefits Group Commercial |
$10.74
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$14.32
|
| Rate for Payer: Networks By Design Commercial |
$11.63
|
| Rate for Payer: Prime Health Services Commercial |
$15.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MMRV 86787
|
Facility
|
OP
|
$29.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900914959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$127.28 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.28
|
| Rate for Payer: Blue Shield of California Commercial |
$19.89
|
| Rate for Payer: Blue Shield of California EPN |
$13.14
|
| Rate for Payer: Cash Price |
$29.73
|
| Rate for Payer: Cash Price |
$29.73
|
| Rate for Payer: Cigna of CA HMO |
$19.03
|
| Rate for Payer: Cigna of CA PPO |
$22.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Senior |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$25.27
|
| Rate for Payer: Global Benefits Group Commercial |
$17.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$23.78
|
| Rate for Payer: Networks By Design Commercial |
$19.32
|
| Rate for Payer: Prime Health Services Commercial |
$25.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SOM MMRV 86787
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900914959
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$25.27 |
| Rate for Payer: Adventist Health Commercial |
$5.95
|
| Rate for Payer: Cash Price |
$29.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.89
|
| Rate for Payer: EPIC Health Plan Senior |
$11.89
|
| Rate for Payer: Galaxy Health WC |
$25.27
|
| Rate for Payer: Global Benefits Group Commercial |
$17.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$23.78
|
| Rate for Payer: Networks By Design Commercial |
$19.32
|
| Rate for Payer: Prime Health Services Commercial |
$25.27
|
|
|
HC SOM MOGS FACS
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$278.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
|
|
HC SOM MOGS FACS
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86363
|
| Hospital Charge Code |
900915461
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.51
|
| Rate for Payer: Blue Shield of California Commercial |
$301.05
|
| Rate for Payer: Blue Shield of California EPN |
$198.90
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna of CA HMO |
$288.00
|
| Rate for Payer: Cigna of CA PPO |
$333.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.77
|
| Rate for Payer: United Healthcare All Other HMO |
$9.77
|
| Rate for Payer: United Healthcare HMO Rider |
$9.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
