|
HC SOM FACTOR V LEIDEN
|
Facility
OP
|
$52.49
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
900915371
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$5,942.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$73.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$73.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$293.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.54
|
| Rate for Payer: BCBS Transplant Transplant |
$31.49
|
| Rate for Payer: Blue Shield of California Commercial |
$32.44
|
| Rate for Payer: Blue Shield of California EPN |
$25.51
|
| Rate for Payer: Caremore Medicare Advantage |
$73.37
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Central Health Plan Commercial |
$41.99
|
| Rate for Payer: Cigna of CA HMO |
$33.59
|
| Rate for Payer: Cigna of CA PPO |
$38.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$73.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.37
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.24
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.37
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$120.33
|
| Rate for Payer: IEHP medi-cal |
$121.06
|
| Rate for Payer: IEHP Medicare Advantage |
$73.37
|
| Rate for Payer: Innovage PACE Commercial |
$110.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$98.32
|
| Rate for Payer: Multiplan Commercial |
$39.37
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$77.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: Riverside University Health MISP |
$80.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.43
|
| Rate for Payer: United Healthcare All Other HMO |
$59.43
|
| Rate for Payer: United Healthcare HMO Rider |
$59.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,942.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.71
|
| Rate for Payer: Vantage Medical Group Senior |
$73.37
|
|
|
HC SOM FANBF 86038
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900914925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$107.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.23
|
| Rate for Payer: BCBS Transplant Transplant |
$45.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46.35
|
| Rate for Payer: Blue Shield of California EPN |
$36.45
|
| Rate for Payer: Caremore Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.09
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$56.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.83
|
| Rate for Payer: IEHP medi-cal |
$19.95
|
| Rate for Payer: IEHP Medicare Advantage |
$12.09
|
| Rate for Payer: Innovage PACE Commercial |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$12.82
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: Riverside University Health MISP |
$13.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.79
|
| Rate for Payer: United Healthcare All Other HMO |
$9.79
|
| Rate for Payer: United Healthcare HMO Rider |
$9.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Vantage Medical Group Senior |
$12.09
|
|
|
HC SOM FANBF 86038
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
900914925
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOM FAP KNOWN MUT EXTRACT
|
Facility
OP
|
$318.21
|
|
|
Service Code
|
CPT 81202
|
| Hospital Charge Code |
900914620
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$280.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$420.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$280.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.25
|
| Rate for Payer: BCBS Transplant Transplant |
$190.93
|
| Rate for Payer: Blue Shield of California Commercial |
$196.65
|
| Rate for Payer: Blue Shield of California EPN |
$154.65
|
| Rate for Payer: Caremore Medicare Advantage |
$280.00
|
| Rate for Payer: Cash Price |
$143.19
|
| Rate for Payer: Cash Price |
$143.19
|
| Rate for Payer: Central Health Plan Commercial |
$254.57
|
| Rate for Payer: Cigna of CA HMO |
$203.65
|
| Rate for Payer: Cigna of CA PPO |
$235.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$270.48
|
| Rate for Payer: Global Benefits Group Commercial |
$190.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$238.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$459.20
|
| Rate for Payer: IEHP medi-cal |
$462.00
|
| Rate for Payer: IEHP Medicare Advantage |
$280.00
|
| Rate for Payer: Innovage PACE Commercial |
$420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$280.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$375.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$375.20
|
| Rate for Payer: Multiplan Commercial |
$238.66
|
| Rate for Payer: Networks By Design Commercial |
$206.84
|
| Rate for Payer: Prime Health Services Commercial |
$270.48
|
| Rate for Payer: Prime Health Services Medicare |
$296.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$190.93
|
| Rate for Payer: Riverside University Health MISP |
$308.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.80
|
| Rate for Payer: United Healthcare All Other HMO |
$226.80
|
| Rate for Payer: United Healthcare HMO Rider |
$226.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Vantage Medical Group Senior |
$280.00
|
|
|
HC SOM FAP KNOWN MUT EXTRACT
|
Facility
IP
|
$318.21
|
|
|
Service Code
|
CPT 81202
|
| Hospital Charge Code |
900914620
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$63.64 |
| Max. Negotiated Rate |
$286.39 |
| Rate for Payer: Cash Price |
$143.19
|
| Rate for Payer: Central Health Plan Commercial |
$254.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$127.28
|
| Rate for Payer: Galaxy Health WC |
$270.48
|
| Rate for Payer: Global Benefits Group Commercial |
$190.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$286.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$212.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.64
|
| Rate for Payer: Multiplan Commercial |
$238.66
|
| Rate for Payer: Networks By Design Commercial |
$206.84
|
| Rate for Payer: Prime Health Services Commercial |
$270.48
|
|
|
HC SOM FASP 86606
|
Facility
IP
|
$77.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$70.02 |
| Rate for Payer: Cash Price |
$35.01
|
| Rate for Payer: Central Health Plan Commercial |
$62.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$66.13
|
| Rate for Payer: Global Benefits Group Commercial |
$46.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.56
|
| Rate for Payer: Multiplan Commercial |
$58.35
|
| Rate for Payer: Networks By Design Commercial |
$50.57
|
| Rate for Payer: Prime Health Services Commercial |
$66.13
|
|
|
HC SOM FASP 86606
|
Facility
OP
|
$77.80
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
900914727
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$133.58 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$15.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.58
|
| Rate for Payer: BCBS Transplant Transplant |
$46.68
|
| Rate for Payer: Blue Shield of California Commercial |
$48.08
|
| Rate for Payer: Blue Shield of California EPN |
$37.81
|
| Rate for Payer: Caremore Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$35.01
|
| Rate for Payer: Cash Price |
$35.01
|
| Rate for Payer: Central Health Plan Commercial |
$62.24
|
| Rate for Payer: Cigna of CA HMO |
$49.79
|
| Rate for Payer: Cigna of CA PPO |
$57.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$66.13
|
| Rate for Payer: Global Benefits Group Commercial |
$46.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.02
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.68
|
| Rate for Payer: IEHP medi-cal |
$24.83
|
| Rate for Payer: IEHP Medicare Advantage |
$15.05
|
| Rate for Payer: Innovage PACE Commercial |
$22.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.17
|
| Rate for Payer: Multiplan Commercial |
$58.35
|
| Rate for Payer: Networks By Design Commercial |
$50.57
|
| Rate for Payer: Prime Health Services Commercial |
$66.13
|
| Rate for Payer: Prime Health Services Medicare |
$15.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$46.68
|
| Rate for Payer: Riverside University Health MISP |
$16.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.20
|
| Rate for Payer: United Healthcare All Other HMO |
$12.20
|
| Rate for Payer: United Healthcare HMO Rider |
$12.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.56
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC SOM FAT FECAL QUANT
|
Facility
OP
|
$28.02
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
900911139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$149.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$16.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.11
|
| Rate for Payer: BCBS Transplant Transplant |
$16.81
|
| Rate for Payer: Blue Shield of California Commercial |
$17.32
|
| Rate for Payer: Blue Shield of California EPN |
$13.62
|
| Rate for Payer: Caremore Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Central Health Plan Commercial |
$22.42
|
| Rate for Payer: Cigna of CA HMO |
$17.93
|
| Rate for Payer: Cigna of CA PPO |
$20.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$23.82
|
| Rate for Payer: Global Benefits Group Commercial |
$16.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$21.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.55
|
| Rate for Payer: IEHP medi-cal |
$27.72
|
| Rate for Payer: IEHP Medicare Advantage |
$16.80
|
| Rate for Payer: Innovage PACE Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Networks By Design Commercial |
$18.21
|
| Rate for Payer: Prime Health Services Commercial |
$23.82
|
| Rate for Payer: Prime Health Services Medicare |
$17.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.81
|
| Rate for Payer: Riverside University Health MISP |
$18.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.61
|
| Rate for Payer: United Healthcare All Other HMO |
$13.61
|
| Rate for Payer: United Healthcare HMO Rider |
$13.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.48
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC SOM FAT FECAL QUANT
|
Facility
IP
|
$28.02
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
900911139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$12.61
|
| Rate for Payer: Central Health Plan Commercial |
$22.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.21
|
| Rate for Payer: Galaxy Health WC |
$23.82
|
| Rate for Payer: Global Benefits Group Commercial |
$16.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$21.02
|
| Rate for Payer: Networks By Design Commercial |
$18.21
|
| Rate for Payer: Prime Health Services Commercial |
$23.82
|
|
|
HC SOM FATTY ACIDS FREE
|
Facility
IP
|
$200.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900910286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM FATTY ACIDS FREE
|
Facility
OP
|
$200.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
900910286
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$96.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.17
|
| Rate for Payer: BCBS Transplant Transplant |
$120.00
|
| Rate for Payer: Blue Shield of California Commercial |
$123.60
|
| Rate for Payer: Blue Shield of California EPN |
$97.20
|
| Rate for Payer: Caremore Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.77
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.78
|
| Rate for Payer: IEHP medi-cal |
$30.97
|
| Rate for Payer: IEHP Medicare Advantage |
$18.77
|
| Rate for Payer: Innovage PACE Commercial |
$28.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.15
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$19.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: Riverside University Health MISP |
$20.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.20
|
| Rate for Payer: United Healthcare All Other HMO |
$15.20
|
| Rate for Payer: United Healthcare HMO Rider |
$15.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.65
|
| Rate for Payer: Vantage Medical Group Senior |
$18.77
|
|
|
HC SOM FATTY ACIDS PEROXISOMAL
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
900911471
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$159.57 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.57
|
| Rate for Payer: BCBS Transplant Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$92.70
|
| Rate for Payer: Blue Shield of California EPN |
$72.90
|
| Rate for Payer: Caremore Medicare Advantage |
$19.75
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| 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 |
$29.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.66
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.75
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.39
|
| Rate for Payer: IEHP medi-cal |
$32.59
|
| Rate for Payer: IEHP Medicare Advantage |
$19.75
|
| Rate for Payer: Innovage PACE Commercial |
$29.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.46
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$20.94
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: Riverside University Health MISP |
$21.72
|
| 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 |
$16.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.72
|
| Rate for Payer: Vantage Medical Group Senior |
$19.75
|
|
|
HC SOM FATTY ACIDS PEROXISOMAL
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
900911471
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 FBIOT 84591
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
900914760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$102.81 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.59
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$18.77
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.81
|
| Rate for Payer: BCBS Transplant Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.60
|
| Rate for Payer: Caremore Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.06
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.98
|
| Rate for Payer: IEHP medi-cal |
$28.15
|
| Rate for Payer: IEHP Medicare Advantage |
$17.06
|
| Rate for Payer: Innovage PACE Commercial |
$25.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$18.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: Riverside University Health MISP |
$18.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.82
|
| Rate for Payer: United Healthcare All Other HMO |
$13.82
|
| Rate for Payer: United Healthcare HMO Rider |
$13.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.77
|
| Rate for Payer: Vantage Medical Group Senior |
$17.06
|
|
|
HC SOM FBIOT 84591
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
900914760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOM FBP1 88273
|
Facility
OP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$1,686.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$34.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,382.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,686.10
|
| Rate for Payer: BCBS Transplant Transplant |
$50.92
|
| Rate for Payer: Blue Shield of California Commercial |
$52.44
|
| Rate for Payer: Blue Shield of California EPN |
$41.24
|
| Rate for Payer: Caremore Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Central Health Plan Commercial |
$67.89
|
| Rate for Payer: Cigna of CA HMO |
$54.31
|
| Rate for Payer: Cigna of CA PPO |
$62.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.81
|
| Rate for Payer: Galaxy Health WC |
$72.13
|
| Rate for Payer: Global Benefits Group Commercial |
$50.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.09
|
| Rate for Payer: IEHP medi-cal |
$57.44
|
| Rate for Payer: IEHP Medicare Advantage |
$34.81
|
| Rate for Payer: Innovage PACE Commercial |
$52.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$63.64
|
| Rate for Payer: Networks By Design Commercial |
$55.16
|
| Rate for Payer: Prime Health Services Commercial |
$72.13
|
| Rate for Payer: Prime Health Services Medicare |
$36.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$50.92
|
| Rate for Payer: Riverside University Health MISP |
$38.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM FBP1 88273
|
Facility
IP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$76.37 |
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Central Health Plan Commercial |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.94
|
| Rate for Payer: Galaxy Health WC |
$72.13
|
| Rate for Payer: Global Benefits Group Commercial |
$50.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.97
|
| Rate for Payer: Multiplan Commercial |
$63.64
|
| Rate for Payer: Networks By Design Commercial |
$55.16
|
| Rate for Payer: Prime Health Services Commercial |
$72.13
|
|
|
HC SOM FBP1 88291
|
Facility
OP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$165.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$155.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$39.13
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$39.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.78
|
| Rate for Payer: BCBS Transplant Transplant |
$42.69
|
| Rate for Payer: Blue Shield of California Commercial |
$43.97
|
| Rate for Payer: Blue Shield of California EPN |
$34.58
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Central Health Plan Commercial |
$56.92
|
| Rate for Payer: Cigna of CA HMO |
$45.54
|
| Rate for Payer: Cigna of CA PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$53.36
|
| Rate for Payer: IEHP medi-cal |
$24.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.23
|
| Rate for Payer: Multiplan Commercial |
$53.36
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.69
|
| Rate for Payer: Riverside University Health MISP |
$28.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.48
|
| Rate for Payer: Vantage Medical Group Senior |
$60.48
|
|
|
HC SOM FBP1 88291
|
Facility
IP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$64.04 |
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Central Health Plan Commercial |
$56.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.23
|
| Rate for Payer: Multiplan Commercial |
$53.36
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
|
|
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: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 FCFQN 86171
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$88.89 |
| Rate for Payer: Adventist Health Medi-Cal |
$10.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.89
|
| Rate for Payer: BCBS Transplant Transplant |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$41.41
|
| Rate for Payer: Blue Shield of California EPN |
$32.56
|
| Rate for Payer: Caremore Medicare Advantage |
$10.01
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.51
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.01
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.42
|
| Rate for Payer: IEHP medi-cal |
$16.52
|
| Rate for Payer: IEHP Medicare Advantage |
$10.01
|
| Rate for Payer: Innovage PACE Commercial |
$15.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.41
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$10.61
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: Riverside University Health MISP |
$11.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10.01
|
|
|
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 |
$173.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: AlphaCare 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 |
$173.90
|
| Rate for Payer: BCBS Transplant Transplant |
$41.74
|
| Rate for Payer: Blue Shield of California Commercial |
$42.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.81
|
| Rate for Payer: Caremore Medicare Advantage |
$19.60
|
| Rate for Payer: Cash Price |
$31.31
|
| Rate for Payer: Cash Price |
$31.31
|
| 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: EPIC Health Plan Commercial |
$26.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$52.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.14
|
| Rate for Payer: IEHP medi-cal |
$32.34
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$59.13
|
| Rate for Payer: Prime Health Services Medicare |
$20.78
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$41.74
|
| Rate for Payer: Riverside University Health 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: 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 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: Cash Price |
$31.31
|
| Rate for Payer: Central Health Plan Commercial |
$55.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 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 |
$49.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: AlphaCare 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 |
$49.52
|
| Rate for Payer: BCBS Transplant Transplant |
$11.89
|
| Rate for Payer: Blue Shield of California Commercial |
$12.24
|
| Rate for Payer: Blue Shield of California EPN |
$9.63
|
| Rate for Payer: Caremore Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Cash Price |
$8.91
|
| 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: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$14.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: IEHP medi-cal |
$9.19
|
| Rate for Payer: 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 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: Prime Health Services Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Medicare |
$5.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.89
|
| Rate for Payer: Riverside University Health 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: 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: Cash Price |
$8.91
|
| Rate for Payer: Central Health Plan Commercial |
$15.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
|
