|
HC SOM CERULOPLASMIN
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$78.12 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.85
|
| Rate for Payer: Blue Shield of California Commercial |
$7.28
|
| Rate for Payer: Blue Shield of California EPN |
$4.76
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: InnovAge PACE Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.74
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Prime Health Services Medicare |
$11.38
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC SOM CERULOPLASMIN
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4.53
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
IP
|
$290.10
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$261.09 |
| Rate for Payer: Adventist Health Commercial |
$58.02
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Central Health Plan Commercial |
$232.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.04
|
| Rate for Payer: EPIC Health Plan Senior |
$116.04
|
| Rate for Payer: Galaxy Health WC |
$246.59
|
| Rate for Payer: Global Benefits Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.02
|
| Rate for Payer: Multiplan Commercial |
$217.57
|
| Rate for Payer: Networks By Design Commercial |
$188.56
|
| Rate for Payer: Prime Health Services Commercial |
$246.59
|
|
|
HC SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
OP
|
$290.10
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$261.09 |
| Rate for Payer: Adventist Health Commercial |
$58.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$246.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.19
|
| Rate for Payer: Blue Shield of California Commercial |
$176.09
|
| Rate for Payer: Blue Shield of California EPN |
$115.17
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Central Health Plan Commercial |
$232.08
|
| Rate for Payer: Cigna of CA HMO |
$185.66
|
| Rate for Payer: Cigna of CA PPO |
$214.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$246.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$246.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.04
|
| Rate for Payer: EPIC Health Plan Senior |
$116.04
|
| Rate for Payer: Galaxy Health WC |
$246.59
|
| Rate for Payer: Global Benefits Group Commercial |
$174.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$261.09
|
| Rate for Payer: InnovAge PACE Commercial |
$145.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$193.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$179.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.07
|
| Rate for Payer: Multiplan Commercial |
$217.57
|
| Rate for Payer: Networks By Design Commercial |
$188.56
|
| Rate for Payer: Prime Health Services Commercial |
$246.59
|
| Rate for Payer: Riverside University Health System MISP |
$116.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.05
|
| Rate for Payer: United Healthcare All Other HMO |
$145.05
|
| Rate for Payer: United Healthcare HMO Rider |
$145.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$246.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$246.59
|
| Rate for Payer: Vantage Medical Group Senior |
$246.59
|
|
|
HC SOM CHLORIDE BF
|
Facility
|
OP
|
$7.01
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900914683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$4.26
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$5.61
|
| Rate for Payer: Cigna of CA HMO |
$4.49
|
| Rate for Payer: Cigna of CA PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Senior |
$5.00
|
| Rate for Payer: Galaxy Health WC |
$5.96
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.96
|
| Rate for Payer: Prime Health Services Medicare |
$5.30
|
| Rate for Payer: Riverside University Health System MISP |
$5.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
|
|
HC SOM CHLORIDE BF
|
Facility
|
IP
|
$7.01
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900914683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$5.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.96
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.96
|
|
|
HC SOM CHOLESTEROL BF
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$100.16
|
| Rate for Payer: Blue Shield of California EPN |
$65.50
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: InnovAge PACE Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.10
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM CHOLESTEROL BF
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
OP
|
$116.50
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Adventist Health Commercial |
$23.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$70.72
|
| Rate for Payer: Blue Shield of California EPN |
$46.25
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Central Health Plan Commercial |
$93.20
|
| Rate for Payer: Cigna of CA HMO |
$74.56
|
| Rate for Payer: Cigna of CA PPO |
$86.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.62
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$99.03
|
| Rate for Payer: Global Benefits Group Commercial |
$69.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.87
|
| Rate for Payer: InnovAge PACE Commercial |
$11.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$87.38
|
| Rate for Payer: Networks By Design Commercial |
$75.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.87
|
| Rate for Payer: Prime Health Services Commercial |
$99.03
|
| Rate for Payer: Prime Health Services Medicare |
$8.34
|
| Rate for Payer: Riverside University Health System MISP |
$8.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO |
$6.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Vantage Medical Group Senior |
$7.87
|
|
|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
IP
|
$116.50
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Adventist Health Commercial |
$23.30
|
| Rate for Payer: Cash Price |
$116.50
|
| Rate for Payer: Central Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.60
|
| Rate for Payer: EPIC Health Plan Senior |
$46.60
|
| Rate for Payer: Galaxy Health WC |
$99.03
|
| Rate for Payer: Global Benefits Group Commercial |
$69.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.30
|
| Rate for Payer: Multiplan Commercial |
$87.38
|
| Rate for Payer: Networks By Design Commercial |
$75.72
|
| Rate for Payer: Prime Health Services Commercial |
$99.03
|
|
|
HC SOM CHRAF CULTURE 03
|
Facility
|
IP
|
$137.52
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Adventist Health Commercial |
$27.50
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Central Health Plan Commercial |
$110.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.01
|
| Rate for Payer: EPIC Health Plan Senior |
$55.01
|
| Rate for Payer: Galaxy Health WC |
$116.89
|
| Rate for Payer: Global Benefits Group Commercial |
$82.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$103.14
|
| Rate for Payer: Networks By Design Commercial |
$89.39
|
| Rate for Payer: Prime Health Services Commercial |
$116.89
|
|
|
HC SOM CHRAF CULTURE 03
|
Facility
|
OP
|
$137.52
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$803.22 |
| Rate for Payer: Adventist Health Commercial |
$27.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.02
|
| Rate for Payer: Blue Shield of California Commercial |
$83.47
|
| Rate for Payer: Blue Shield of California EPN |
$54.60
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Central Health Plan Commercial |
$110.02
|
| Rate for Payer: Cigna of CA HMO |
$88.01
|
| Rate for Payer: Cigna of CA PPO |
$101.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$116.89
|
| Rate for Payer: Global Benefits Group Commercial |
$82.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: InnovAge PACE Commercial |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$103.14
|
| Rate for Payer: Networks By Design Commercial |
$89.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: Prime Health Services Commercial |
$116.89
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Riverside University Health System MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRBM CULTURE 04
|
Facility
|
IP
|
$101.87
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$91.68 |
| Rate for Payer: Adventist Health Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Central Health Plan Commercial |
$81.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.75
|
| Rate for Payer: EPIC Health Plan Senior |
$40.75
|
| Rate for Payer: Galaxy Health WC |
$86.59
|
| Rate for Payer: Global Benefits Group Commercial |
$61.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Multiplan Commercial |
$76.40
|
| Rate for Payer: Networks By Design Commercial |
$66.22
|
| Rate for Payer: Prime Health Services Commercial |
$86.59
|
|
|
HC SOM CHRBM CULTURE 04
|
Facility
|
OP
|
$101.87
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$780.06 |
| Rate for Payer: Adventist Health Commercial |
$20.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.31
|
| Rate for Payer: Blue Shield of California Commercial |
$61.84
|
| Rate for Payer: Blue Shield of California EPN |
$40.44
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Central Health Plan Commercial |
$81.50
|
| Rate for Payer: Cigna of CA HMO |
$65.20
|
| Rate for Payer: Cigna of CA PPO |
$75.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Senior |
$143.75
|
| Rate for Payer: Galaxy Health WC |
$86.59
|
| Rate for Payer: Global Benefits Group Commercial |
$61.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: InnovAge PACE Commercial |
$215.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$76.40
|
| Rate for Payer: Networks By Design Commercial |
$66.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.75
|
| Rate for Payer: Prime Health Services Commercial |
$86.59
|
| Rate for Payer: Prime Health Services Medicare |
$152.38
|
| Rate for Payer: Riverside University Health System MISP |
$158.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
|
OP
|
$89.11
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$719.52 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$116.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$719.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.03
|
| Rate for Payer: Blue Shield of California Commercial |
$54.09
|
| Rate for Payer: Blue Shield of California EPN |
$35.38
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Central Health Plan Commercial |
$71.29
|
| Rate for Payer: Cigna of CA HMO |
$57.03
|
| Rate for Payer: Cigna of CA PPO |
$65.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.26
|
| Rate for Payer: EPIC Health Plan Senior |
$116.49
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: InnovAge PACE Commercial |
$174.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$156.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$116.49
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
| Rate for Payer: Prime Health Services Medicare |
$123.48
|
| Rate for Payer: Riverside University Health System MISP |
$128.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
|
IP
|
$89.11
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$80.20 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Central Health Plan Commercial |
$71.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
|
IP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$319.05 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Central Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.80
|
| Rate for Payer: EPIC Health Plan Senior |
$141.80
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.90
|
| Rate for Payer: Multiplan Commercial |
$265.88
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
|
OP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$803.22 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.02
|
| Rate for Payer: Blue Shield of California Commercial |
$215.18
|
| Rate for Payer: Blue Shield of California EPN |
$140.74
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Central Health Plan Commercial |
$283.60
|
| Rate for Payer: Cigna of CA HMO |
$226.88
|
| Rate for Payer: Cigna of CA PPO |
$262.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.91
|
| Rate for Payer: EPIC Health Plan Senior |
$150.30
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: InnovAge PACE Commercial |
$225.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$265.88
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Riverside University Health System MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
IP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$143.39 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Central Health Plan Commercial |
$127.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.73
|
| Rate for Payer: EPIC Health Plan Senior |
$63.73
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.86
|
| Rate for Payer: Multiplan Commercial |
$119.49
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
OP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$780.06 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.31
|
| Rate for Payer: Blue Shield of California Commercial |
$96.71
|
| Rate for Payer: Blue Shield of California EPN |
$63.25
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Central Health Plan Commercial |
$127.46
|
| Rate for Payer: Cigna of CA HMO |
$101.96
|
| Rate for Payer: Cigna of CA PPO |
$117.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.06
|
| Rate for Payer: EPIC Health Plan Senior |
$143.75
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: InnovAge PACE Commercial |
$215.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$119.49
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.75
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
| Rate for Payer: Prime Health Services Medicare |
$152.38
|
| Rate for Payer: Riverside University Health System MISP |
$158.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
OP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$1,038.51 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$147.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,038.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.77
|
| Rate for Payer: Blue Shield of California Commercial |
$108.31
|
| Rate for Payer: Blue Shield of California EPN |
$70.84
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Central Health Plan Commercial |
$142.75
|
| Rate for Payer: Cigna of CA HMO |
$114.20
|
| Rate for Payer: Cigna of CA PPO |
$132.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.15
|
| Rate for Payer: EPIC Health Plan Senior |
$147.52
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: InnovAge PACE Commercial |
$221.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$147.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$133.83
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$147.52
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
| Rate for Payer: Prime Health Services Medicare |
$156.37
|
| Rate for Payer: Riverside University Health System MISP |
$162.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
IP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$160.60 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Central Health Plan Commercial |
$142.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.38
|
| Rate for Payer: EPIC Health Plan Senior |
$71.38
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.69
|
| Rate for Payer: Multiplan Commercial |
$133.83
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
|
|
HC SOM CHROMIUM
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$147.52 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.94
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| 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 |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.38
|
| Rate for Payer: EPIC Health Plan Senior |
$20.28
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: InnovAge PACE Commercial |
$30.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.28
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$21.50
|
| Rate for Payer: Riverside University Health System MISP |
$22.31
|
| 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 |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO |
$16.43
|
| Rate for Payer: United Healthcare HMO Rider |
$16.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$20.28
|
|
