|
HC SOM FCFQN 86171
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC SOM FCTRC 87110
|
Facility
|
IP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Central Health Plan Commercial |
$55.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.83
|
| Rate for Payer: EPIC Health Plan Senior |
$27.83
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.91
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
|
|
HC SOM FCTRC 87110
|
Facility
|
OP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$142.57 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.94
|
| Rate for Payer: Blue Shield of California Commercial |
$42.23
|
| Rate for Payer: Blue Shield of California EPN |
$27.62
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Central Health Plan Commercial |
$55.66
|
| Rate for Payer: Cigna of CA HMO |
$44.52
|
| Rate for Payer: Cigna of CA PPO |
$51.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.46
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.60
|
| Rate for Payer: InnovAge PACE Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.60
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
| Rate for Payer: Prime Health Services Medicare |
$20.78
|
| Rate for Payer: Riverside University Health System MISP |
$21.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.88
|
| Rate for Payer: United Healthcare All Other HMO |
$15.88
|
| Rate for Payer: United Healthcare HMO Rider |
$15.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Vantage Medical Group Senior |
$19.60
|
|
|
HC SOM FCTRC 87140
|
Facility
|
OP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$40.60 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.24
|
| Rate for Payer: Blue Shield of California Commercial |
$12.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.85
|
| Rate for Payer: Cigna of CA HMO |
$12.68
|
| Rate for Payer: Cigna of CA PPO |
$14.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Senior |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$16.84
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: InnovAge PACE Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Medicare |
$5.90
|
| Rate for Payer: Riverside University Health System MISP |
$6.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC SOM FCTRC 87140
|
Facility
|
IP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.84
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$16.84
|
|
|
HC SOM FDSAC 82657
|
Facility
|
OP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$152.03 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$102.53
|
| Rate for Payer: Blue Shield of California EPN |
$67.06
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Central Health Plan Commercial |
$135.14
|
| Rate for Payer: Cigna of CA HMO |
$108.11
|
| Rate for Payer: Cigna of CA PPO |
$125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.93
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$143.58
|
| Rate for Payer: Global Benefits Group Commercial |
$101.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: InnovAge PACE Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$126.69
|
| Rate for Payer: Networks By Design Commercial |
$109.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$143.58
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM FDSAC 82657
|
Facility
|
IP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$152.03 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Central Health Plan Commercial |
$135.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.57
|
| Rate for Payer: EPIC Health Plan Senior |
$67.57
|
| Rate for Payer: Galaxy Health WC |
$143.58
|
| Rate for Payer: Global Benefits Group Commercial |
$101.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$104.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.78
|
| Rate for Payer: Multiplan Commercial |
$126.69
|
| Rate for Payer: Networks By Design Commercial |
$109.80
|
| Rate for Payer: Prime Health Services Commercial |
$143.58
|
|
|
HC SOM FDXM 82542
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$130.82 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$61.31
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: InnovAge PACE Commercial |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FDXM 82542
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC SOM FEAGR 86682
|
Facility
|
IP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$47.31 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Central Health Plan Commercial |
$42.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.03
|
| Rate for Payer: EPIC Health Plan Senior |
$21.03
|
| Rate for Payer: Galaxy Health WC |
$44.68
|
| Rate for Payer: Global Benefits Group Commercial |
$31.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$39.43
|
| Rate for Payer: Networks By Design Commercial |
$34.17
|
| Rate for Payer: Prime Health Services Commercial |
$44.68
|
|
|
HC SOM FEAGR 86682
|
Facility
|
OP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.38
|
| Rate for Payer: Blue Shield of California Commercial |
$31.91
|
| Rate for Payer: Blue Shield of California EPN |
$20.87
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Central Health Plan Commercial |
$42.06
|
| Rate for Payer: Cigna of CA HMO |
$33.64
|
| Rate for Payer: Cigna of CA PPO |
$38.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Senior |
$13.01
|
| Rate for Payer: Galaxy Health WC |
$44.68
|
| Rate for Payer: Global Benefits Group Commercial |
$31.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: InnovAge PACE Commercial |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$39.43
|
| Rate for Payer: Networks By Design Commercial |
$34.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.01
|
| Rate for Payer: Prime Health Services Commercial |
$44.68
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Riverside University Health System MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM FELBAMATE S
|
Facility
|
OP
|
$21.17
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| Rate for Payer: Blue Shield of California Commercial |
$12.85
|
| Rate for Payer: Blue Shield of California EPN |
$8.40
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$16.94
|
| Rate for Payer: Cigna of CA HMO |
$13.55
|
| Rate for Payer: Cigna of CA PPO |
$15.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$15.88
|
| Rate for Payer: Networks By Design Commercial |
$13.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM FELBAMATE S
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Adventist Health Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Central Health Plan Commercial |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.47
|
| Rate for Payer: EPIC Health Plan Senior |
$8.47
|
| Rate for Payer: Galaxy Health WC |
$17.99
|
| Rate for Payer: Global Benefits Group Commercial |
$12.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.23
|
| Rate for Payer: Multiplan Commercial |
$15.88
|
| Rate for Payer: Networks By Design Commercial |
$13.76
|
| Rate for Payer: Prime Health Services Commercial |
$17.99
|
|
|
HC SOM FENTU
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$135.76 |
| Rate for Payer: Adventist Health Commercial |
$9.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.55
|
| 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 |
$38.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.25
|
| 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: InnovAge PACE Commercial |
$22.50
|
| 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: Molina Healthcare of CA Medi-Cal |
$31.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.50
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$18.00
|
| 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 |
$22.50
|
| Rate for Payer: United Healthcare All Other HMO |
$22.50
|
| Rate for Payer: United Healthcare HMO Rider |
$22.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.25
|
| Rate for Payer: Vantage Medical Group Senior |
$38.25
|
|
|
HC SOM FENTU
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| 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 FESC 83789
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$130.82 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$82.55
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.55
|
| Rate for Payer: EPIC Health Plan Senior |
$24.11
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: InnovAge PACE Commercial |
$36.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.11
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Riverside University Health System MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM FESC 83789
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC SOM FFTP 86780
|
Facility
|
OP
|
$28.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914768
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$126.21 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.62
|
| Rate for Payer: Blue Shield of California Commercial |
$17.36
|
| Rate for Payer: Blue Shield of California EPN |
$11.35
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.88
|
| Rate for Payer: Cigna of CA HMO |
$18.30
|
| Rate for Payer: Cigna of CA PPO |
$21.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Senior |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$24.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: InnovAge PACE Commercial |
$19.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
| Rate for Payer: Networks By Design Commercial |
$18.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$24.31
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Riverside University Health System MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM FFTP 86780
|
Facility
|
IP
|
$28.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914768
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.74 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.44
|
| Rate for Payer: EPIC Health Plan Senior |
$11.44
|
| Rate for Payer: Galaxy Health WC |
$24.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
| Rate for Payer: Networks By Design Commercial |
$18.59
|
| Rate for Payer: Prime Health Services Commercial |
$24.31
|
|
|
HC SOM FHBG 87912
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
900914883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$1,482.58 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$257.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,482.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$300.89
|
| Rate for Payer: Blue Shield of California Commercial |
$227.62
|
| Rate for Payer: Blue Shield of California EPN |
$148.88
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$240.00
|
| Rate for Payer: Cigna of CA PPO |
$277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.56
|
| Rate for Payer: EPIC Health Plan Senior |
$257.45
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$422.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: InnovAge PACE Commercial |
$386.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$257.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.98
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$257.45
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
| Rate for Payer: Prime Health Services Medicare |
$272.90
|
| Rate for Payer: Riverside University Health System MISP |
$283.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.54
|
| Rate for Payer: United Healthcare All Other HMO |
$208.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$257.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM FHBG 87912
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
900914883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
|
HC SOM FHSII 86696
|
Facility
|
OP
|
$37.37
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$140.71 |
| Rate for Payer: Adventist Health Commercial |
$7.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.56
|
| Rate for Payer: Blue Shield of California Commercial |
$22.68
|
| Rate for Payer: Blue Shield of California EPN |
$14.84
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Central Health Plan Commercial |
$29.90
|
| Rate for Payer: Cigna of CA HMO |
$23.92
|
| Rate for Payer: Cigna of CA PPO |
$27.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$31.76
|
| Rate for Payer: Global Benefits Group Commercial |
$22.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: InnovAge PACE Commercial |
$29.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$28.03
|
| Rate for Payer: Networks By Design Commercial |
$24.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$31.76
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM FHSII 86696
|
Facility
|
IP
|
$37.37
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$33.63 |
| Rate for Payer: Adventist Health Commercial |
$7.47
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Central Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Senior |
$14.95
|
| Rate for Payer: Galaxy Health WC |
$31.76
|
| Rate for Payer: Global Benefits Group Commercial |
$22.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$28.03
|
| Rate for Payer: Networks By Design Commercial |
$24.29
|
| Rate for Payer: Prime Health Services Commercial |
$31.76
|
|
|
HC SOM FHTL 87798A
|
Facility
|
OP
|
$112.81
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.51
|
| 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 |
$68.48
|
| Rate for Payer: Blue Shield of California EPN |
$44.79
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Central Health Plan Commercial |
$90.25
|
| Rate for Payer: Cigna of CA HMO |
$72.20
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| 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 |
$95.89
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.53
|
| 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 |
$75.24
|
| 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 |
$22.56
|
| 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 |
$84.61
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$95.89
|
| 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 |
$67.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.69
|
| 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 FHTL 87798A
|
Facility
|
IP
|
$112.81
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$101.53 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Central Health Plan Commercial |
$90.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.12
|
| Rate for Payer: EPIC Health Plan Senior |
$45.12
|
| Rate for Payer: Galaxy Health WC |
$95.89
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: Prime Health Services Commercial |
$95.89
|
|
