|
HC SOM MGLE P/Q TYPE CA CHANNEL AB
|
Facility
IP
|
$176.17
|
|
|
Service Code
|
CPT 86596
|
| Hospital Charge Code |
900915420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.23 |
| Max. Negotiated Rate |
$158.55 |
| Rate for Payer: Cash Price |
$79.28
|
| Rate for Payer: Central Health Plan Commercial |
$140.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.47
|
| Rate for Payer: Galaxy Health WC |
$149.74
|
| Rate for Payer: Global Benefits Group Commercial |
$105.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.23
|
| Rate for Payer: Multiplan Commercial |
$132.13
|
| Rate for Payer: Networks By Design Commercial |
$114.51
|
| Rate for Payer: Prime Health Services Commercial |
$149.74
|
|
|
HC SOM MGLES 83519A
|
Facility
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: BCBS Transplant Transplant |
$75.84
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$61.43
|
| Rate for Payer: Caremore Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: IEHP medi-cal |
$30.36
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Innovage PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: Riverside University Health MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519A
|
Facility
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914809
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83519B
|
Facility
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83519B
|
Facility
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914811
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: BCBS Transplant Transplant |
$75.84
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$61.43
|
| Rate for Payer: Caremore Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: IEHP medi-cal |
$30.36
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Innovage PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: Riverside University Health MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519C
|
Facility
IP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.77 |
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.45
|
| Rate for Payer: Global Benefits Group Commercial |
$75.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
| Rate for Payer: Networks By Design Commercial |
$82.17
|
| Rate for Payer: Prime Health Services Commercial |
$107.45
|
|
|
HC SOM MGLES 83519C
|
Facility
OP
|
$126.41
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: BCBS Transplant Transplant |
$75.85
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$61.44
|
| Rate for Payer: Caremore Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.13
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.45
|
| Rate for Payer: Global Benefits Group Commercial |
$75.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.77
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: IEHP medi-cal |
$30.36
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Innovage PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.81
|
| Rate for Payer: Networks By Design Commercial |
$82.17
|
| Rate for Payer: Prime Health Services Commercial |
$107.45
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.85
|
| Rate for Payer: Riverside University Health MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519D
|
Facility
OP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$119.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.90
|
| Rate for Payer: BCBS Transplant Transplant |
$75.84
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$61.43
|
| Rate for Payer: Caremore Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: Cigna of CA HMO |
$80.90
|
| Rate for Payer: Cigna of CA PPO |
$93.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.40
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$94.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.18
|
| Rate for Payer: IEHP medi-cal |
$30.36
|
| Rate for Payer: IEHP Medicare Advantage |
$18.40
|
| Rate for Payer: Innovage PACE Commercial |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
| Rate for Payer: Prime Health Services Medicare |
$19.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: Riverside University Health MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.24
|
| Rate for Payer: Vantage Medical Group Senior |
$18.40
|
|
|
HC SOM MGLES 83519D
|
Facility
IP
|
$126.40
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
900914813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Central Health Plan Commercial |
$101.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.56
|
| Rate for Payer: Galaxy Health WC |
$107.44
|
| Rate for Payer: Global Benefits Group Commercial |
$75.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.28
|
| Rate for Payer: Multiplan Commercial |
$94.80
|
| Rate for Payer: Networks By Design Commercial |
$82.16
|
| Rate for Payer: Prime Health Services Commercial |
$107.44
|
|
|
HC SOM MGLES 83520
|
Facility
IP
|
$121.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$109.05 |
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Central Health Plan Commercial |
$96.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.47
|
| Rate for Payer: Galaxy Health WC |
$102.99
|
| Rate for Payer: Global Benefits Group Commercial |
$72.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.23
|
| Rate for Payer: Multiplan Commercial |
$90.88
|
| Rate for Payer: Networks By Design Commercial |
$78.76
|
| Rate for Payer: Prime Health Services Commercial |
$102.99
|
|
|
HC SOM MGLES 83520
|
Facility
OP
|
$121.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914810
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.88
|
| Rate for Payer: BCBS Transplant Transplant |
$72.70
|
| Rate for Payer: Blue Shield of California Commercial |
$74.88
|
| Rate for Payer: Blue Shield of California EPN |
$58.89
|
| Rate for Payer: Caremore Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Central Health Plan Commercial |
$96.94
|
| Rate for Payer: Cigna of CA HMO |
$77.55
|
| Rate for Payer: Cigna of CA PPO |
$89.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.27
|
| Rate for Payer: Galaxy Health WC |
$102.99
|
| Rate for Payer: Global Benefits Group Commercial |
$72.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: IEHP medi-cal |
$28.50
|
| Rate for Payer: IEHP Medicare Advantage |
$17.27
|
| Rate for Payer: Innovage PACE Commercial |
$25.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$90.88
|
| Rate for Payer: Networks By Design Commercial |
$78.76
|
| Rate for Payer: Prime Health Services Commercial |
$102.99
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$72.70
|
| Rate for Payer: Riverside University Health MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM MICROSPORIDIA CULTURE
|
Facility
OP
|
$100.06
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900912827
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$90.05 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.26
|
| Rate for Payer: BCBS Transplant Transplant |
$60.04
|
| Rate for Payer: Blue Shield of California Commercial |
$61.84
|
| Rate for Payer: Blue Shield of California EPN |
$48.63
|
| Rate for Payer: Caremore Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Central Health Plan Commercial |
$80.05
|
| Rate for Payer: Cigna of CA HMO |
$64.04
|
| Rate for Payer: Cigna of CA PPO |
$74.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$85.05
|
| Rate for Payer: Global Benefits Group Commercial |
$60.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.05
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.04
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.96
|
| Rate for Payer: IEHP medi-cal |
$11.02
|
| Rate for Payer: IEHP Medicare Advantage |
$6.68
|
| Rate for Payer: Innovage PACE Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$75.04
|
| Rate for Payer: Networks By Design Commercial |
$65.04
|
| Rate for Payer: Prime Health Services Commercial |
$85.05
|
| Rate for Payer: Prime Health Services Medicare |
$7.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$60.04
|
| Rate for Payer: Riverside University Health MISP |
$7.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC SOM MICROSPORIDIA CULTURE
|
Facility
IP
|
$100.06
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900912827
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$90.05 |
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Central Health Plan Commercial |
$80.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.02
|
| Rate for Payer: Galaxy Health WC |
$85.05
|
| Rate for Payer: Global Benefits Group Commercial |
$60.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.01
|
| Rate for Payer: Multiplan Commercial |
$75.04
|
| Rate for Payer: Networks By Design Commercial |
$65.04
|
| Rate for Payer: Prime Health Services Commercial |
$85.05
|
|
|
HC SOM MICROSPORIDIA DETECTION
|
Facility
IP
|
$89.72
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911588
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Central Health Plan Commercial |
$71.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.89
|
| Rate for Payer: Galaxy Health WC |
$76.26
|
| Rate for Payer: Global Benefits Group Commercial |
$53.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.94
|
| Rate for Payer: Multiplan Commercial |
$67.29
|
| Rate for Payer: Networks By Design Commercial |
$58.32
|
| Rate for Payer: Prime Health Services Commercial |
$76.26
|
|
|
HC SOM MICROSPORIDIA DETECTION
|
Facility
OP
|
$89.72
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911588
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.99
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.17
|
| Rate for Payer: BCBS Transplant Transplant |
$53.83
|
| Rate for Payer: Blue Shield of California Commercial |
$55.45
|
| Rate for Payer: Blue Shield of California EPN |
$43.60
|
| Rate for Payer: Caremore Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Central Health Plan Commercial |
$71.78
|
| Rate for Payer: Cigna of CA HMO |
$57.42
|
| Rate for Payer: Cigna of CA PPO |
$66.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.09
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.99
|
| Rate for Payer: Galaxy Health WC |
$76.26
|
| Rate for Payer: Global Benefits Group Commercial |
$53.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.75
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.29
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.82
|
| Rate for Payer: IEHP medi-cal |
$9.88
|
| Rate for Payer: IEHP Medicare Advantage |
$5.99
|
| Rate for Payer: Innovage PACE Commercial |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$67.29
|
| Rate for Payer: Networks By Design Commercial |
$58.32
|
| Rate for Payer: Prime Health Services Commercial |
$76.26
|
| Rate for Payer: Prime Health Services Medicare |
$6.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$53.83
|
| Rate for Payer: Riverside University Health MISP |
$6.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC SOM MILK PROCESSED IGE
|
Facility
IP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
|
|
HC SOM MILK PROCESSED IGE
|
Facility
OP
|
$4.75
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914157
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: BCBS Transplant Transplant |
$2.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2.94
|
| Rate for Payer: Blue Shield of California EPN |
$2.31
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.80
|
| Rate for Payer: Cigna of CA HMO |
$3.04
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$4.04
|
| Rate for Payer: Global Benefits Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3.56
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: IEHP medi-cal |
$8.61
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Innovage PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$3.56
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.04
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: Riverside University Health MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM MIRA VISTA HC HISTOPLASMA AG
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
900913883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: BCBS Transplant Transplant |
$84.00
|
| Rate for Payer: Blue Shield of California Commercial |
$86.52
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Caremore Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.25
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$105.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.73
|
| Rate for Payer: IEHP medi-cal |
$21.86
|
| Rate for Payer: IEHP Medicare Advantage |
$13.25
|
| Rate for Payer: Innovage PACE Commercial |
$19.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.76
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
| Rate for Payer: Prime Health Services Medicare |
$14.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: Riverside University Health MISP |
$14.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.74
|
| Rate for Payer: United Healthcare All Other HMO |
$10.74
|
| Rate for Payer: United Healthcare HMO Rider |
$10.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.58
|
| Rate for Payer: Vantage Medical Group Senior |
$13.25
|
|
|
HC SOM MIRA VISTA HC HISTOPLASMA AG
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 87385
|
| Hospital Charge Code |
900913883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Central Health Plan Commercial |
$112.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.00
|
| Rate for Payer: Galaxy Health WC |
$119.00
|
| Rate for Payer: Global Benefits Group Commercial |
$84.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$105.00
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$119.00
|
|
|
HC SOM MITOCHONDRIAL ANTIBO
|
Facility
IP
|
$10.82
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
900911178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$9.74 |
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.33
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Multiplan Commercial |
$8.12
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
|
|
HC SOM MITOCHONDRIAL ANTIBO
|
Facility
OP
|
$10.82
|
|
|
Service Code
|
CPT 86381
|
| Hospital Charge Code |
900911178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$132.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.21
|
| Rate for Payer: BCBS Transplant Transplant |
$6.49
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.26
|
| Rate for Payer: Caremore Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Central Health Plan Commercial |
$8.66
|
| Rate for Payer: Cigna of CA HMO |
$6.92
|
| Rate for Payer: Cigna of CA PPO |
$8.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.45
|
| Rate for Payer: Galaxy Health WC |
$9.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.74
|
| Rate for Payer: IEHP medi-cal |
$41.99
|
| Rate for Payer: IEHP Medicare Advantage |
$25.45
|
| Rate for Payer: Innovage PACE Commercial |
$38.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$8.12
|
| Rate for Payer: Networks By Design Commercial |
$7.03
|
| Rate for Payer: Prime Health Services Commercial |
$9.20
|
| Rate for Payer: Prime Health Services Medicare |
$26.98
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.49
|
| Rate for Payer: Riverside University Health MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.62
|
| Rate for Payer: United Healthcare All Other HMO |
$20.62
|
| Rate for Payer: United Healthcare HMO Rider |
$20.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.00
|
| Rate for Payer: Vantage Medical Group Senior |
$25.45
|
|
|
HC SOM MMRV 86735
|
Facility
IP
|
$100.43
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900914957
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Cash Price |
$45.19
|
| Rate for Payer: Central Health Plan Commercial |
$80.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.17
|
| Rate for Payer: Galaxy Health WC |
$85.37
|
| Rate for Payer: Global Benefits Group Commercial |
$60.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$75.32
|
| Rate for Payer: Networks By Design Commercial |
$65.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.37
|
|
|
HC SOM MMRV 86735
|
Facility
OP
|
$100.43
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900914957
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$117.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.03
|
| Rate for Payer: BCBS Transplant Transplant |
$60.26
|
| Rate for Payer: Blue Shield of California Commercial |
$62.07
|
| Rate for Payer: Blue Shield of California EPN |
$48.81
|
| Rate for Payer: Caremore Medicare Advantage |
$13.05
|
| Rate for Payer: Cash Price |
$45.19
|
| Rate for Payer: Cash Price |
$45.19
|
| Rate for Payer: Central Health Plan Commercial |
$80.34
|
| Rate for Payer: Cigna of CA HMO |
$64.28
|
| Rate for Payer: Cigna of CA PPO |
$74.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.05
|
| Rate for Payer: Galaxy Health WC |
$85.37
|
| Rate for Payer: Global Benefits Group Commercial |
$60.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.39
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$75.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: IEHP medi-cal |
$21.53
|
| Rate for Payer: IEHP Medicare Advantage |
$13.05
|
| Rate for Payer: Innovage PACE Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$75.32
|
| Rate for Payer: Networks By Design Commercial |
$65.28
|
| Rate for Payer: Prime Health Services Commercial |
$85.37
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$60.26
|
| Rate for Payer: Riverside University Health MISP |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC SOM MMRV 86762
|
Facility
OP
|
$70.05
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900914958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$127.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.31
|
| Rate for Payer: BCBS Transplant Transplant |
$42.03
|
| Rate for Payer: Blue Shield of California Commercial |
$43.29
|
| Rate for Payer: Blue Shield of California EPN |
$34.04
|
| Rate for Payer: Caremore Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$31.52
|
| Rate for Payer: Cash Price |
$31.52
|
| Rate for Payer: Central Health Plan Commercial |
$56.04
|
| Rate for Payer: Cigna of CA HMO |
$44.83
|
| Rate for Payer: Cigna of CA PPO |
$51.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$59.54
|
| Rate for Payer: Global Benefits Group Commercial |
$42.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$52.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: IEHP medi-cal |
$23.74
|
| Rate for Payer: IEHP Medicare Advantage |
$14.39
|
| Rate for Payer: Innovage PACE Commercial |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$52.54
|
| Rate for Payer: Networks By Design Commercial |
$45.53
|
| Rate for Payer: Prime Health Services Commercial |
$59.54
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$42.03
|
| Rate for Payer: Riverside University Health MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC SOM MMRV 86762
|
Facility
IP
|
$70.05
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900914958
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Cash Price |
$31.52
|
| Rate for Payer: Central Health Plan Commercial |
$56.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.02
|
| Rate for Payer: Galaxy Health WC |
$59.54
|
| Rate for Payer: Global Benefits Group Commercial |
$42.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.01
|
| Rate for Payer: Multiplan Commercial |
$52.54
|
| Rate for Payer: Networks By Design Commercial |
$45.53
|
| Rate for Payer: Prime Health Services Commercial |
$59.54
|
|
