|
HC SOM SEROTONIN BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$305.95 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.95
|
| Rate for Payer: Blue Shield of California Commercial |
$20.07
|
| Rate for Payer: Blue Shield of California EPN |
$13.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.82
|
| Rate for Payer: EPIC Health Plan Senior |
$30.98
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.51
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$214.52 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.52
|
| Rate for Payer: Blue Shield of California Commercial |
$8.70
|
| Rate for Payer: Blue Shield of California EPN |
$5.75
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.34
|
| Rate for Payer: EPIC Health Plan Senior |
$21.73
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.60
|
| Rate for Payer: United Healthcare All Other HMO |
$17.60
|
| Rate for Payer: United Healthcare HMO Rider |
$17.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$841.19 |
| Rate for Payer: EPIC Health Plan Senior |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| 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 |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$841.19
|
| 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 |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| 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 |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
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 SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
OP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$31.99 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.99
|
| Rate for Payer: Blue Shield of California Commercial |
$11.33
|
| Rate for Payer: Blue Shield of California EPN |
$7.48
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$12.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$14.39
|
| Rate for Payer: Global Benefits Group Commercial |
$10.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$13.54
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
IP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.77
|
| Rate for Payer: EPIC Health Plan Senior |
$6.77
|
| Rate for Payer: Galaxy Health WC |
$14.39
|
| Rate for Payer: Global Benefits Group Commercial |
$10.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.06
|
| Rate for Payer: Multiplan Commercial |
$13.54
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.39
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.75
|
| Rate for Payer: Blue Shield of California Commercial |
$163.91
|
| Rate for Payer: Blue Shield of California EPN |
$108.29
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.68
|
| Rate for Payer: EPIC Health Plan Senior |
$18.28
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Vantage Medical Group Senior |
$18.28
|
|
|
HC SOM SOTALOL
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$143.83 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.83
|
| Rate for Payer: Blue Shield of California Commercial |
$55.01
|
| Rate for Payer: Blue Shield of California EPN |
$36.35
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$60.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$65.78
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SOTALOL
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.89
|
| Rate for Payer: EPIC Health Plan Senior |
$32.89
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.74
|
| Rate for Payer: Multiplan Commercial |
$65.78
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.94
|
| Rate for Payer: Blue Shield of California Commercial |
$24.08
|
| Rate for Payer: Blue Shield of California EPN |
$15.91
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM SPN 87206
|
Facility
|
IP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$41.38 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.47
|
| Rate for Payer: EPIC Health Plan Senior |
$19.47
|
| Rate for Payer: Galaxy Health WC |
$41.38
|
| Rate for Payer: Global Benefits Group Commercial |
$29.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Multiplan Commercial |
$38.94
|
| Rate for Payer: Networks By Design Commercial |
$31.64
|
| Rate for Payer: Prime Health Services Commercial |
$41.38
|
|
|
HC SOM SPN 87206
|
Facility
|
OP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$41.38
|
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.06
|
| Rate for Payer: Blue Shield of California Commercial |
$32.57
|
| Rate for Payer: Blue Shield of California EPN |
$21.52
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cigna of CA HMO |
$31.16
|
| Rate for Payer: Cigna of CA PPO |
$36.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: Global Benefits Group Commercial |
$29.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$38.94
|
| Rate for Payer: Networks By Design Commercial |
$31.64
|
| Rate for Payer: Prime Health Services Commercial |
$41.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SOM SSDNA 86226
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOM SSDNA 86226
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$119.63 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.63
|
| Rate for Payer: Blue Shield of California Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California EPN |
$24.31
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Senior |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC SOM ST2
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.15 |
| Max. Negotiated Rate |
$123.87 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.29
|
| Rate for Payer: EPIC Health Plan Senior |
$58.29
|
| Rate for Payer: Galaxy Health WC |
$123.87
|
| Rate for Payer: Global Benefits Group Commercial |
$87.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$90.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.98
|
| Rate for Payer: Multiplan Commercial |
$116.58
|
| Rate for Payer: Networks By Design Commercial |
$94.72
|
| Rate for Payer: Prime Health Services Commercial |
$123.87
|
|
|
HC SOM ST2
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 83006
|
| Hospital Charge Code |
900915314
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.15 |
| Max. Negotiated Rate |
$163.05 |
| Rate for Payer: Adventist Health Commercial |
$29.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.05
|
| Rate for Payer: Blue Shield of California Commercial |
$97.49
|
| Rate for Payer: Blue Shield of California EPN |
$64.41
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cash Price |
$145.73
|
| Rate for Payer: Cigna of CA HMO |
$93.27
|
| Rate for Payer: Cigna of CA PPO |
$107.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.06
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$123.87
|
| Rate for Payer: Global Benefits Group Commercial |
$87.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.30
|
| Rate for Payer: Multiplan Commercial |
$116.58
|
| Rate for Payer: Networks By Design Commercial |
$94.72
|
| Rate for Payer: Prime Health Services Commercial |
$123.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.24
|
| Rate for Payer: United Healthcare All Other HMO |
$61.24
|
| Rate for Payer: United Healthcare HMO Rider |
$61.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.16
|
| Rate for Payer: Vantage Medical Group Senior |
$75.60
|
|
|
HC SOM ST LOUIS ENCEPH AB IGM
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ST LOUIS ENCEPH AB IGM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900912812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM ST LOUIS ENCEPHALITIS AB IGG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
900911336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC SOM STONE ANALYSIS
|
Facility
|
IP
|
$16.63
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$14.14 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.65
|
| Rate for Payer: EPIC Health Plan Senior |
$6.65
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$13.30
|
| Rate for Payer: Networks By Design Commercial |
$10.81
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
|
|
HC SOM STONE ANALYSIS
|
Facility
|
OP
|
$16.63
|
|
|
Service Code
|
CPT 82365
|
| Hospital Charge Code |
900911025
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$127.41 |
| Rate for Payer: Adventist Health Commercial |
$3.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11.13
|
| Rate for Payer: Blue Shield of California EPN |
$7.35
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cigna of CA HMO |
$10.64
|
| Rate for Payer: Cigna of CA PPO |
$12.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.41
|
| Rate for Payer: EPIC Health Plan Senior |
$12.90
|
| Rate for Payer: Galaxy Health WC |
$14.14
|
| Rate for Payer: Global Benefits Group Commercial |
$9.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.29
|
| Rate for Payer: Multiplan Commercial |
$13.30
|
| Rate for Payer: Networks By Design Commercial |
$10.81
|
| Rate for Payer: Prime Health Services Commercial |
$14.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.45
|
| Rate for Payer: United Healthcare All Other HMO |
$10.45
|
| Rate for Payer: United Healthcare HMO Rider |
$10.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.19
|
| Rate for Payer: Vantage Medical Group Senior |
$12.90
|
|
