|
HC SOM COCCI AB IGG CSF BY ID
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM COCCI AB IGM CSF BY ID
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: InnovAge PACE Commercial |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.18
|
| Rate for Payer: Blue Shield of California Commercial |
$7.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: InnovAge PACE Commercial |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY CF
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGG BY ID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900911752
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.18
|
| Rate for Payer: Blue Shield of California Commercial |
$8.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.36
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$8.64
|
| Rate for Payer: Cigna of CA PPO |
$9.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: InnovAge PACE Commercial |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$84.63 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.18
|
| Rate for Payer: Blue Shield of California Commercial |
$8.19
|
| Rate for Payer: Blue Shield of California EPN |
$5.36
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$8.64
|
| Rate for Payer: Cigna of CA PPO |
$9.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.48
|
| Rate for Payer: EPIC Health Plan Senior |
$11.47
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.47
|
| Rate for Payer: InnovAge PACE Commercial |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.47
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
| Rate for Payer: Prime Health Services Medicare |
$12.16
|
| Rate for Payer: Riverside University Health System MISP |
$12.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Other HMO |
$9.29
|
| Rate for Payer: United Healthcare HMO Rider |
$9.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.62
|
| Rate for Payer: Vantage Medical Group Senior |
$11.47
|
|
|
HC SOM COCCIDIOIDES AB IGM BY ID
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
900912668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Adventist Health Commercial |
$2.70
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Central Health Plan Commercial |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5.40
|
| Rate for Payer: Galaxy Health WC |
$11.47
|
| Rate for Payer: Global Benefits Group Commercial |
$8.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$10.12
|
| Rate for Payer: Networks By Design Commercial |
$8.78
|
| Rate for Payer: Prime Health Services Commercial |
$11.47
|
|
|
HC SOM COCCIDOIDES PCR
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| 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 |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$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 |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| 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 |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| 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 |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM COCCIDOIDES PCR
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900915439
|
|
Hospital Revenue Code
|
300
|
| 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 COLONIES 1-6
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Central Health Plan Commercial |
$75.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.50
|
| Rate for Payer: EPIC Health Plan Senior |
$37.50
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
|
|
HC SOM COLONIES 1-6
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
900915300
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$1,209.88 |
| Rate for Payer: Adventist Health Commercial |
$18.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$173.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,209.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.55
|
| Rate for Payer: Blue Shield of California Commercial |
$56.91
|
| Rate for Payer: Blue Shield of California EPN |
$37.22
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Cash Price |
$93.75
|
| Rate for Payer: Central Health Plan Commercial |
$75.00
|
| Rate for Payer: Cigna of CA HMO |
$60.00
|
| Rate for Payer: Cigna of CA PPO |
$69.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.44
|
| Rate for Payer: EPIC Health Plan Senior |
$173.66
|
| Rate for Payer: Galaxy Health WC |
$79.69
|
| Rate for Payer: Global Benefits Group Commercial |
$56.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.38
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$284.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.66
|
| Rate for Payer: InnovAge PACE Commercial |
$260.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$232.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.70
|
| Rate for Payer: Multiplan Commercial |
$70.31
|
| Rate for Payer: Networks By Design Commercial |
$60.94
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$173.66
|
| Rate for Payer: Prime Health Services Commercial |
$79.69
|
| Rate for Payer: Prime Health Services Medicare |
$184.08
|
| Rate for Payer: Riverside University Health System MISP |
$191.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.66
|
| Rate for Payer: United Healthcare All Other HMO |
$140.66
|
| Rate for Payer: United Healthcare HMO Rider |
$140.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$260.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.03
|
| Rate for Payer: Vantage Medical Group Senior |
$173.66
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOM COMPLEMENT C1Q
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911109
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$87.33 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.72
|
| 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 |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| 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 |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| 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 |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| 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 |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$177.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.98
|
| Rate for Payer: Blue Shield of California Commercial |
$52.20
|
| Rate for Payer: Blue Shield of California EPN |
$34.14
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.90
|
| Rate for Payer: EPIC Health Plan Senior |
$24.37
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.37
|
| Rate for Payer: InnovAge PACE Commercial |
$36.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.66
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.37
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$25.83
|
| Rate for Payer: Riverside University Health System MISP |
$26.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.74
|
| Rate for Payer: United Healthcare All Other HMO |
$19.74
|
| Rate for Payer: United Healthcare HMO Rider |
$19.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.81
|
| Rate for Payer: Vantage Medical Group Senior |
$24.37
|
|
|
HC SOM COMPLEMENT C1Q BINDING
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
900911097
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Adventist Health Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: EPIC Health Plan Senior |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOM COMPLEMENT C-2
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
900911110
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$87.33 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.72
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.00
|
| Rate for Payer: EPIC Health Plan Senior |
$18.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
|
|
HC SOM COMPLEMENT C-5
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
900911042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$87.33 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.72
|
| Rate for Payer: Blue Shield of California Commercial |
$27.32
|
| Rate for Payer: Blue Shield of California EPN |
$17.86
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$36.00
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.00
|
| Rate for Payer: InnovAge PACE Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$33.75
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.00
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Prime Health Services Medicare |
$12.72
|
| Rate for Payer: Riverside University Health System MISP |
$13.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.72
|
| Rate for Payer: United Healthcare All Other HMO |
$9.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Vantage Medical Group Senior |
$12.00
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Central Health Plan Commercial |
$11.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.53
|
| Rate for Payer: EPIC Health Plan Senior |
$5.53
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
|
|
HC SOM COMPLEMENT TOTAL
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
900915322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$147.76 |
| Rate for Payer: Adventist Health Commercial |
$2.77
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.99
|
| Rate for Payer: Blue Shield of California Commercial |
$8.39
|
| Rate for Payer: Blue Shield of California EPN |
$5.49
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Central Health Plan Commercial |
$11.06
|
| Rate for Payer: Cigna of CA HMO |
$8.85
|
| Rate for Payer: Cigna of CA PPO |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.43
|
| Rate for Payer: EPIC Health Plan Senior |
$20.32
|
| Rate for Payer: Galaxy Health WC |
$11.76
|
| Rate for Payer: Global Benefits Group Commercial |
$8.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.32
|
| Rate for Payer: InnovAge PACE Commercial |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.23
|
| Rate for Payer: Multiplan Commercial |
$10.37
|
| Rate for Payer: Networks By Design Commercial |
$8.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.32
|
| Rate for Payer: Prime Health Services Commercial |
$11.76
|
| Rate for Payer: Prime Health Services Medicare |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$22.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.46
|
| Rate for Payer: United Healthcare All Other HMO |
$16.46
|
| Rate for Payer: United Healthcare HMO Rider |
$16.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.32
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SOM CONF HC DRUG ABUSE SUR 12, U
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900912913
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$91.05
|
| Rate for Payer: Blue Shield of California EPN |
$59.55
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
