|
HC SOM META 1-10
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900915301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$1,382.33 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$34.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,382.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.55
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Senior |
$34.81
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: InnovAge PACE Commercial |
$52.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| 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 |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$34.81
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$36.90
|
| Rate for Payer: Riverside University Health System MISP |
$38.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Upland Medical Group Pediatric |
$34.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC SOM META 1-19
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM META 1-19
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915297
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$144.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$902.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.20
|
| Rate for Payer: Blue Shield of California Commercial |
$75.88
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.22
|
| Rate for Payer: EPIC Health Plan Senior |
$144.61
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: InnovAge PACE Commercial |
$216.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$144.61
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$153.29
|
| Rate for Payer: Riverside University Health System MISP |
$159.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 1-20
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$906.71 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$125.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$906.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.02
|
| Rate for Payer: Blue Shield of California Commercial |
$106.22
|
| Rate for Payer: Blue Shield of California EPN |
$69.47
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.41
|
| Rate for Payer: EPIC Health Plan Senior |
$125.49
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$205.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$185.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: InnovAge PACE Commercial |
$188.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$125.49
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Prime Health Services Medicare |
$133.02
|
| Rate for Payer: Riverside University Health System MISP |
$138.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.65
|
| Rate for Payer: United Healthcare All Other HMO |
$101.65
|
| Rate for Payer: United Healthcare HMO Rider |
$101.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$125.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META 1-20
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915293
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM META 1-25
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM META 1-25
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$1,047.86 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$173.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,047.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.67
|
| Rate for Payer: Blue Shield of California Commercial |
$75.88
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.78
|
| Rate for Payer: EPIC Health Plan Senior |
$173.17
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$284.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.17
|
| Rate for Payer: InnovAge PACE Commercial |
$259.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$232.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.05
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$173.17
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$183.56
|
| Rate for Payer: Riverside University Health System MISP |
$190.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.26
|
| Rate for Payer: United Healthcare All Other HMO |
$140.26
|
| Rate for Payer: United Healthcare HMO Rider |
$140.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META 20-25
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$144.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$902.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.20
|
| Rate for Payer: Blue Shield of California Commercial |
$106.22
|
| Rate for Payer: Blue Shield of California EPN |
$69.47
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.22
|
| Rate for Payer: EPIC Health Plan Senior |
$144.61
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: InnovAge PACE Commercial |
$216.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$144.61
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Prime Health Services Medicare |
$153.29
|
| Rate for Payer: Riverside University Health System MISP |
$159.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META 20-25
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915295
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$117.40 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.83
|
| Rate for Payer: Blue Shield of California Commercial |
$7.25
|
| Rate for Payer: Blue Shield of California EPN |
$4.74
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Central Health Plan Commercial |
$9.56
|
| Rate for Payer: Cigna of CA HMO |
$7.65
|
| Rate for Payer: Cigna of CA PPO |
$8.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$10.16
|
| Rate for Payer: Global Benefits Group Commercial |
$7.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.76
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: InnovAge PACE Commercial |
$40.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.91
|
| Rate for Payer: Prime Health Services Commercial |
$10.16
|
| Rate for Payer: Prime Health Services Medicare |
$28.52
|
| Rate for Payer: Riverside University Health System MISP |
$29.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 15 CHROM ADDIT
|
Facility
|
IP
|
$11.95
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915304
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: Adventist Health Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Central Health Plan Commercial |
$9.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.78
|
| Rate for Payer: EPIC Health Plan Senior |
$4.78
|
| Rate for Payer: Galaxy Health WC |
$10.16
|
| Rate for Payer: Global Benefits Group Commercial |
$7.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$8.96
|
| Rate for Payer: Networks By Design Commercial |
$7.77
|
| Rate for Payer: Prime Health Services Commercial |
$10.16
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
|
IP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$101.75 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Central Health Plan Commercial |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.22
|
| Rate for Payer: EPIC Health Plan Senior |
$45.22
|
| Rate for Payer: Galaxy Health WC |
$96.09
|
| Rate for Payer: Global Benefits Group Commercial |
$67.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.61
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
| Rate for Payer: Networks By Design Commercial |
$73.48
|
| Rate for Payer: Prime Health Services Commercial |
$96.09
|
|
|
HC SOM META GT 15 CHROM ANAL
|
Facility
|
OP
|
$113.05
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915298
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$1,307.78 |
| Rate for Payer: Adventist Health Commercial |
$22.61
|
| Rate for Payer: Adventist Health Medi-Cal |
$188.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,307.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.42
|
| Rate for Payer: Blue Shield of California Commercial |
$68.62
|
| Rate for Payer: Blue Shield of California EPN |
$44.88
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Cash Price |
$113.05
|
| Rate for Payer: Central Health Plan Commercial |
$90.44
|
| Rate for Payer: Cigna of CA HMO |
$72.35
|
| Rate for Payer: Cigna of CA PPO |
$83.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.57
|
| Rate for Payer: EPIC Health Plan Senior |
$188.57
|
| Rate for Payer: Galaxy Health WC |
$96.09
|
| Rate for Payer: Global Benefits Group Commercial |
$67.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$309.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: InnovAge PACE Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$84.79
|
| Rate for Payer: Networks By Design Commercial |
$73.48
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$188.57
|
| Rate for Payer: Prime Health Services Commercial |
$96.09
|
| Rate for Payer: Prime Health Services Medicare |
$199.88
|
| Rate for Payer: Riverside University Health System MISP |
$207.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.74
|
| Rate for Payer: United Healthcare All Other HMO |
$152.74
|
| Rate for Payer: United Healthcare HMO Rider |
$152.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$188.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
|
OP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$906.71 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$125.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$906.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.02
|
| Rate for Payer: Blue Shield of California Commercial |
$65.84
|
| Rate for Payer: Blue Shield of California EPN |
$43.06
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Central Health Plan Commercial |
$86.77
|
| Rate for Payer: Cigna of CA HMO |
$69.41
|
| Rate for Payer: Cigna of CA PPO |
$80.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.41
|
| Rate for Payer: EPIC Health Plan Senior |
$125.49
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$205.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$185.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$125.49
|
| Rate for Payer: InnovAge PACE Commercial |
$188.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$125.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.16
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$125.49
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
| Rate for Payer: Prime Health Services Medicare |
$133.02
|
| Rate for Payer: Riverside University Health System MISP |
$138.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.65
|
| Rate for Payer: United Healthcare All Other HMO |
$101.65
|
| Rate for Payer: United Healthcare HMO Rider |
$101.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$125.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.04
|
| Rate for Payer: Vantage Medical Group Senior |
$125.49
|
|
|
HC SOM META GT 20 CHROM ANAL
|
Facility
|
IP
|
$108.46
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
900915294
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Central Health Plan Commercial |
$86.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.38
|
| Rate for Payer: EPIC Health Plan Senior |
$43.38
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
|
OP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$117.40 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.83
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.57
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Central Health Plan Commercial |
$13.23
|
| Rate for Payer: Cigna of CA HMO |
$10.59
|
| Rate for Payer: Cigna of CA PPO |
$12.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$14.06
|
| Rate for Payer: Global Benefits Group Commercial |
$9.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.89
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: InnovAge PACE Commercial |
$40.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
| Rate for Payer: Networks By Design Commercial |
$10.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.91
|
| Rate for Payer: Prime Health Services Commercial |
$14.06
|
| Rate for Payer: Prime Health Services Medicare |
$28.52
|
| Rate for Payer: Riverside University Health System MISP |
$29.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 25 CHROM ADDIT
|
Facility
|
IP
|
$16.54
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915305
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$16.54
|
| Rate for Payer: Central Health Plan Commercial |
$13.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.06
|
| Rate for Payer: Global Benefits Group Commercial |
$9.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.40
|
| Rate for Payer: Networks By Design Commercial |
$10.75
|
| Rate for Payer: Prime Health Services Commercial |
$14.06
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
|
OP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$144.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$902.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.20
|
| Rate for Payer: Blue Shield of California Commercial |
$65.84
|
| Rate for Payer: Blue Shield of California EPN |
$43.06
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Central Health Plan Commercial |
$86.77
|
| Rate for Payer: Cigna of CA HMO |
$69.41
|
| Rate for Payer: Cigna of CA PPO |
$80.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.22
|
| Rate for Payer: EPIC Health Plan Senior |
$144.61
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$237.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$144.61
|
| Rate for Payer: InnovAge PACE Commercial |
$216.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.78
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$144.61
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
| Rate for Payer: Prime Health Services Medicare |
$153.29
|
| Rate for Payer: Riverside University Health System MISP |
$159.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.14
|
| Rate for Payer: United Healthcare All Other HMO |
$117.14
|
| Rate for Payer: United Healthcare HMO Rider |
$117.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$144.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$216.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.07
|
| Rate for Payer: Vantage Medical Group Senior |
$144.61
|
|
|
HC SOM META GT 25 CHROM ANAL
|
Facility
|
IP
|
$108.46
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
900915296
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$97.61 |
| Rate for Payer: Adventist Health Commercial |
$21.69
|
| Rate for Payer: Cash Price |
$108.46
|
| Rate for Payer: Central Health Plan Commercial |
$86.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.38
|
| Rate for Payer: EPIC Health Plan Senior |
$43.38
|
| Rate for Payer: Galaxy Health WC |
$92.19
|
| Rate for Payer: Global Benefits Group Commercial |
$65.08
|
| Rate for Payer: Health Management Network EPO/PPO |
$97.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$81.34
|
| Rate for Payer: Networks By Design Commercial |
$70.50
|
| Rate for Payer: Prime Health Services Commercial |
$92.19
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Central Health Plan Commercial |
$11.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.66
|
| Rate for Payer: EPIC Health Plan Senior |
$5.66
|
| Rate for Payer: Galaxy Health WC |
$12.03
|
| Rate for Payer: Global Benefits Group Commercial |
$8.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
| Rate for Payer: Networks By Design Commercial |
$9.20
|
| Rate for Payer: Prime Health Services Commercial |
$12.03
|
|
|
HC SOM META GT 26 CHROM ADDIT
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 88285
|
| Hospital Charge Code |
900915306
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$117.40 |
| Rate for Payer: Adventist Health Commercial |
$2.83
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.83
|
| Rate for Payer: Blue Shield of California Commercial |
$8.59
|
| Rate for Payer: Blue Shield of California EPN |
$5.62
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Central Health Plan Commercial |
$11.32
|
| Rate for Payer: Cigna of CA HMO |
$9.06
|
| Rate for Payer: Cigna of CA PPO |
$10.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.33
|
| Rate for Payer: EPIC Health Plan Senior |
$26.91
|
| Rate for Payer: Galaxy Health WC |
$12.03
|
| Rate for Payer: Global Benefits Group Commercial |
$8.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.73
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$44.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.91
|
| Rate for Payer: InnovAge PACE Commercial |
$40.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$36.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.06
|
| Rate for Payer: Multiplan Commercial |
$10.61
|
| Rate for Payer: Networks By Design Commercial |
$9.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.91
|
| Rate for Payer: Prime Health Services Commercial |
$12.03
|
| Rate for Payer: Prime Health Services Medicare |
$28.52
|
| Rate for Payer: Riverside University Health System MISP |
$29.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.80
|
| Rate for Payer: United Healthcare All Other HMO |
$21.80
|
| Rate for Payer: United Healthcare HMO Rider |
$21.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.60
|
| Rate for Payer: Vantage Medical Group Senior |
$26.91
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
OP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$1,047.86 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Adventist Health Medi-Cal |
$173.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,047.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.67
|
| Rate for Payer: Blue Shield of California Commercial |
$67.29
|
| Rate for Payer: Blue Shield of California EPN |
$44.01
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Central Health Plan Commercial |
$88.68
|
| Rate for Payer: Cigna of CA HMO |
$70.94
|
| Rate for Payer: Cigna of CA PPO |
$82.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.78
|
| Rate for Payer: EPIC Health Plan Senior |
$173.17
|
| Rate for Payer: Galaxy Health WC |
$94.22
|
| Rate for Payer: Global Benefits Group Commercial |
$66.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$284.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$173.17
|
| Rate for Payer: InnovAge PACE Commercial |
$259.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$173.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$232.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$232.05
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
| Rate for Payer: Networks By Design Commercial |
$72.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$173.17
|
| Rate for Payer: Prime Health Services Commercial |
$94.22
|
| Rate for Payer: Prime Health Services Medicare |
$183.56
|
| Rate for Payer: Riverside University Health System MISP |
$190.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.26
|
| Rate for Payer: United Healthcare All Other HMO |
$140.26
|
| Rate for Payer: United Healthcare HMO Rider |
$140.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.26
|
| Rate for Payer: Upland Medical Group Pediatric |
$173.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.49
|
| Rate for Payer: Vantage Medical Group Senior |
$173.17
|
|
|
HC SOM META GT 26 CHROM ANAL
|
Facility
|
IP
|
$110.85
|
|
|
Service Code
|
CPT 88245
|
| Hospital Charge Code |
900915292
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$99.77 |
| Rate for Payer: Adventist Health Commercial |
$22.17
|
| Rate for Payer: Cash Price |
$110.85
|
| Rate for Payer: Central Health Plan Commercial |
$88.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.34
|
| Rate for Payer: EPIC Health Plan Senior |
$44.34
|
| Rate for Payer: Galaxy Health WC |
$94.22
|
| Rate for Payer: Global Benefits Group Commercial |
$66.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.17
|
| Rate for Payer: Multiplan Commercial |
$83.14
|
| Rate for Payer: Networks By Design Commercial |
$72.05
|
| Rate for Payer: Prime Health Services Commercial |
$94.22
|
|
|
HC SOM META LT 15
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM META LT 15
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
900915299
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$1,307.78 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$188.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,307.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.42
|
| Rate for Payer: Blue Shield of California Commercial |
$75.88
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.57
|
| Rate for Payer: EPIC Health Plan Senior |
$188.57
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$309.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$274.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$188.57
|
| Rate for Payer: InnovAge PACE Commercial |
$282.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.68
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$188.57
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$199.88
|
| Rate for Payer: Riverside University Health System MISP |
$207.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.74
|
| Rate for Payer: United Healthcare All Other HMO |
$152.74
|
| Rate for Payer: United Healthcare HMO Rider |
$152.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$188.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.43
|
| Rate for Payer: Vantage Medical Group Senior |
$188.57
|
|
