|
HC SOM MENMS 81405
|
Facility
|
IP
|
$556.35
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914742
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$111.27 |
| Max. Negotiated Rate |
$472.90 |
| Rate for Payer: Adventist Health Commercial |
$111.27
|
| Rate for Payer: Cash Price |
$556.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$389.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.54
|
| Rate for Payer: EPIC Health Plan Senior |
$222.54
|
| Rate for Payer: Galaxy Health WC |
$472.90
|
| Rate for Payer: Global Benefits Group Commercial |
$333.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$353.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$328.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.52
|
| Rate for Payer: Multiplan Commercial |
$445.08
|
| Rate for Payer: Networks By Design Commercial |
$361.63
|
| Rate for Payer: Prime Health Services Commercial |
$472.90
|
|
|
HC SOM MEPERIDINE
|
Facility
|
IP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$83.54 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Senior |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.54
|
| Rate for Payer: Global Benefits Group Commercial |
$58.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.59
|
| Rate for Payer: Multiplan Commercial |
$78.62
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.54
|
|
|
HC SOM MEPERIDINE
|
Facility
|
OP
|
$98.28
|
|
|
Service Code
|
CPT 80362
|
| Hospital Charge Code |
900910758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$192.62 |
| Rate for Payer: Adventist Health Commercial |
$19.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.62
|
| Rate for Payer: Blue Shield of California Commercial |
$45.31
|
| Rate for Payer: Blue Shield of California Commercial |
$68.50
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Cigna of CA HMO |
$62.90
|
| Rate for Payer: Cigna of CA PPO |
$72.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.31
|
| Rate for Payer: EPIC Health Plan Senior |
$39.31
|
| Rate for Payer: Galaxy Health WC |
$83.54
|
| Rate for Payer: Global Benefits Group Commercial |
$58.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.80
|
| Rate for Payer: Multiplan Commercial |
$78.62
|
| Rate for Payer: Networks By Design Commercial |
$63.88
|
| Rate for Payer: Prime Health Services Commercial |
$83.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.14
|
| Rate for Payer: United Healthcare All Other HMO |
$49.14
|
| Rate for Payer: United Healthcare HMO Rider |
$49.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.54
|
| Rate for Payer: Vantage Medical Group Senior |
$83.54
|
|
|
HC SOM MERCURY BLOOD
|
Facility
|
IP
|
$23.51
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Adventist Health Commercial |
$4.70
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9.40
|
| Rate for Payer: Galaxy Health WC |
$19.98
|
| Rate for Payer: Global Benefits Group Commercial |
$14.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.64
|
| Rate for Payer: Multiplan Commercial |
$18.81
|
| Rate for Payer: Networks By Design Commercial |
$15.28
|
| Rate for Payer: Prime Health Services Commercial |
$19.98
|
|
|
HC SOM MERCURY BLOOD
|
Facility
|
OP
|
$23.51
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
900910759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Adventist Health Commercial |
$4.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.05
|
| Rate for Payer: Blue Shield of California Commercial |
$10.84
|
| Rate for Payer: Blue Shield of California Commercial |
$16.39
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cash Price |
$23.51
|
| Rate for Payer: Cigna of CA HMO |
$15.05
|
| Rate for Payer: Cigna of CA PPO |
$17.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.83
|
| Rate for Payer: EPIC Health Plan Senior |
$17.89
|
| Rate for Payer: Galaxy Health WC |
$19.98
|
| Rate for Payer: Global Benefits Group Commercial |
$14.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$18.81
|
| Rate for Payer: Networks By Design Commercial |
$15.28
|
| Rate for Payer: Prime Health Services Commercial |
$19.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.17
|
| Rate for Payer: United Healthcare All Other HMO |
$13.17
|
| Rate for Payer: United Healthcare HMO Rider |
$13.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.17
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.89
|
| Rate for Payer: Vantage Medical Group Senior |
$16.26
|
|
|
HC SOM META 1-10
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| 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
|
|
|
HC SOM META 1-10
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,961.26 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,961.26
|
| Rate for Payer: Blue Shield of California Commercial |
$13.83
|
| Rate for Payer: Blue Shield of California Commercial |
$20.91
|
| 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 |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.44
|
| Rate for Payer: EPIC Health Plan Senior |
$38.29
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$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 |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM META 1-19
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM META 1-19
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$1,280.75 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,036.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,280.75
|
| Rate for Payer: Blue Shield of California Commercial |
$57.62
|
| Rate for Payer: Blue Shield of California Commercial |
$87.12
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.61
|
| Rate for Payer: EPIC Health Plan Senior |
$159.07
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 1-20
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM META 1-20
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$1,286.45 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,036.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,286.45
|
| Rate for Payer: Blue Shield of California Commercial |
$121.97
|
| Rate for Payer: Blue Shield of California Commercial |
$80.67
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.06
|
| Rate for Payer: EPIC Health Plan Senior |
$138.04
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$205.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.65
|
| Rate for Payer: United Healthcare All Other HMO |
$101.65
|
| Rate for Payer: United Healthcare HMO Rider |
$101.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$125.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META 1-25
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$106.25 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM META 1-25
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$1,486.72 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,079.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,486.72
|
| Rate for Payer: Blue Shield of California Commercial |
$57.62
|
| Rate for Payer: Blue Shield of California Commercial |
$87.12
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.73
|
| Rate for Payer: EPIC Health Plan Senior |
$190.49
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$284.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$288.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.05
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.26
|
| Rate for Payer: United Healthcare All Other HMO |
$140.26
|
| Rate for Payer: United Healthcare HMO Rider |
$140.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META 20-25
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$1,280.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,036.50
|
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,280.75
|
| Rate for Payer: Blue Shield of California Commercial |
$121.97
|
| Rate for Payer: Blue Shield of California Commercial |
$80.67
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.61
|
| Rate for Payer: EPIC Health Plan Senior |
$159.07
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 20-25
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.57
|
| Rate for Payer: Blue Shield of California Commercial |
$5.51
|
| Rate for Payer: Blue Shield of California Commercial |
$8.33
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cigna of CA HMO |
$7.65
|
| Rate for Payer: Cigna of CA PPO |
$8.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$10.16
|
| Rate for Payer: Global Benefits Group Commercial |
$7.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$9.56
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$10.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
|
IP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.16 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.78
|
| Rate for Payer: Galaxy Health WC |
$10.16
|
| Rate for Payer: Global Benefits Group Commercial |
$7.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$9.56
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$10.16
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
|
IP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$96.09 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.22
|
| Rate for Payer: EPIC Health Plan Senior |
$45.22
|
| Rate for Payer: Galaxy Health WC |
$96.09
|
| Rate for Payer: Global Benefits Group Commercial |
$67.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.13
|
| Rate for Payer: Multiplan Commercial |
$90.44
|
| Rate for Payer: Networks By Design Commercial |
$73.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.09
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
|
OP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$1,855.50 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,494.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,855.50
|
| Rate for Payer: Blue Shield of California Commercial |
$52.12
|
| Rate for Payer: Blue Shield of California Commercial |
$78.80
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Cigna of CA HMO |
$72.35
|
| Rate for Payer: Cigna of CA PPO |
$83.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.14
|
| Rate for Payer: EPIC Health Plan Senior |
$207.43
|
| Rate for Payer: Galaxy Health WC |
$96.09
|
| Rate for Payer: Global Benefits Group Commercial |
$67.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$309.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$303.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$90.44
|
| Rate for Payer: Networks By Design Commercial |
$73.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.74
|
| Rate for Payer: United Healthcare All Other HMO |
$152.74
|
| Rate for Payer: United Healthcare HMO Rider |
$152.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$188.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
|
IP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$92.19 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.38
|
| Rate for Payer: EPIC Health Plan Senior |
$43.38
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.03
|
| Rate for Payer: Multiplan Commercial |
$86.77
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
|
OP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$1,286.45 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,036.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,286.45
|
| Rate for Payer: Blue Shield of California Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cigna of CA HMO |
$69.41
|
| Rate for Payer: Cigna of CA PPO |
$80.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.06
|
| Rate for Payer: EPIC Health Plan Senior |
$138.04
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$205.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$86.77
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.65
|
| Rate for Payer: United Healthcare All Other HMO |
$101.65
|
| Rate for Payer: United Healthcare HMO Rider |
$101.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$125.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
|
IP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.06 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.06
|
| Rate for Payer: Global Benefits Group Commercial |
$9.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$13.23
|
| Rate for Payer: Networks By Design Commercial |
$10.75
|
| Rate for Payer: Prime Health Services Commercial |
$14.06
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
|
OP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$166.57 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.57
|
| Rate for Payer: Blue Shield of California Commercial |
$11.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.62
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$14.06
|
| Rate for Payer: Global Benefits Group Commercial |
$9.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$13.23
|
| Rate for Payer: Networks By Design Commercial |
$10.75
|
| Rate for Payer: Prime Health Services Commercial |
$14.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
|
OP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$1,280.75 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,036.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,280.75
|
| Rate for Payer: Blue Shield of California Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cigna of CA HMO |
$69.41
|
| Rate for Payer: Cigna of CA PPO |
$80.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.61
|
| Rate for Payer: EPIC Health Plan Senior |
$159.07
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$194.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$202.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$86.77
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
|
IP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$92.19 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$75.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.38
|
| Rate for Payer: EPIC Health Plan Senior |
$43.38
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$68.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.03
|
| Rate for Payer: Multiplan Commercial |
$86.77
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
|
