|
HC SOM SEBV IGM
|
Facility
|
IP
|
$11.26
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.13 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.50
|
| Rate for Payer: EPIC Health Plan Senior |
$4.50
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
|
|
HC SOM SEBV IGM
|
Facility
|
OP
|
$11.26
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
900915455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.81
|
| Rate for Payer: Blue Shield of California Commercial |
$6.83
|
| Rate for Payer: Blue Shield of California EPN |
$4.47
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Central Health Plan Commercial |
$9.01
|
| Rate for Payer: Cigna of CA HMO |
$7.21
|
| Rate for Payer: Cigna of CA PPO |
$8.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.49
|
| Rate for Payer: EPIC Health Plan Senior |
$18.14
|
| Rate for Payer: Galaxy Health WC |
$9.57
|
| Rate for Payer: Global Benefits Group Commercial |
$6.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.13
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.14
|
| Rate for Payer: InnovAge PACE Commercial |
$27.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.31
|
| Rate for Payer: Multiplan Commercial |
$8.45
|
| Rate for Payer: Networks By Design Commercial |
$7.32
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.14
|
| Rate for Payer: Prime Health Services Commercial |
$9.57
|
| Rate for Payer: Prime Health Services Medicare |
$19.23
|
| Rate for Payer: Riverside University Health System MISP |
$19.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.70
|
| Rate for Payer: United Healthcare All Other HMO |
$14.70
|
| Rate for Payer: United Healthcare HMO Rider |
$14.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.14
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
OP
|
$264.70
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$238.23 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.22
|
| Rate for Payer: Blue Shield of California Commercial |
$160.67
|
| Rate for Payer: Blue Shield of California EPN |
$105.09
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Central Health Plan Commercial |
$211.76
|
| Rate for Payer: Cigna of CA HMO |
$169.41
|
| Rate for Payer: Cigna of CA PPO |
$195.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.88
|
| Rate for Payer: EPIC Health Plan Senior |
$105.88
|
| Rate for Payer: Galaxy Health WC |
$225.00
|
| Rate for Payer: Global Benefits Group Commercial |
$158.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.23
|
| Rate for Payer: InnovAge PACE Commercial |
$132.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.29
|
| Rate for Payer: Multiplan Commercial |
$198.53
|
| Rate for Payer: Networks By Design Commercial |
$172.06
|
| Rate for Payer: Prime Health Services Commercial |
$225.00
|
| Rate for Payer: Riverside University Health System MISP |
$105.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.35
|
| Rate for Payer: United Healthcare All Other HMO |
$132.35
|
| Rate for Payer: United Healthcare HMO Rider |
$132.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.00
|
| Rate for Payer: Vantage Medical Group Senior |
$225.00
|
|
|
HC SOM SECOBARBITAL
|
Facility
|
IP
|
$264.70
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$238.23 |
| Rate for Payer: Adventist Health Commercial |
$52.94
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Central Health Plan Commercial |
$211.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.88
|
| Rate for Payer: EPIC Health Plan Senior |
$105.88
|
| Rate for Payer: Galaxy Health WC |
$225.00
|
| Rate for Payer: Global Benefits Group Commercial |
$158.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.94
|
| Rate for Payer: Multiplan Commercial |
$198.53
|
| Rate for Payer: Networks By Design Commercial |
$172.06
|
| Rate for Payer: Prime Health Services Commercial |
$225.00
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
OP
|
$25.62
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$185.77 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$185.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.70
|
| Rate for Payer: Blue Shield of California Commercial |
$15.55
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Central Health Plan Commercial |
$20.50
|
| Rate for Payer: Cigna of CA HMO |
$16.40
|
| Rate for Payer: Cigna of CA PPO |
$18.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.47
|
| Rate for Payer: EPIC Health Plan Senior |
$25.53
|
| Rate for Payer: Galaxy Health WC |
$21.78
|
| Rate for Payer: Global Benefits Group Commercial |
$15.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.06
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$41.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.53
|
| Rate for Payer: InnovAge PACE Commercial |
$38.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.21
|
| Rate for Payer: Multiplan Commercial |
$19.21
|
| Rate for Payer: Networks By Design Commercial |
$16.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.53
|
| Rate for Payer: Prime Health Services Commercial |
$21.78
|
| Rate for Payer: Prime Health Services Medicare |
$27.06
|
| Rate for Payer: Riverside University Health System MISP |
$28.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.68
|
| Rate for Payer: United Healthcare All Other HMO |
$20.68
|
| Rate for Payer: United Healthcare HMO Rider |
$20.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.08
|
| Rate for Payer: Vantage Medical Group Senior |
$25.53
|
|
|
HC SOM SELENIUM URINE
|
Facility
|
IP
|
$25.62
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
900911019
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$23.06 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$25.62
|
| Rate for Payer: Central Health Plan Commercial |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.25
|
| Rate for Payer: EPIC Health Plan Senior |
$10.25
|
| Rate for Payer: Galaxy Health WC |
$21.78
|
| Rate for Payer: Global Benefits Group Commercial |
$15.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.12
|
| Rate for Payer: Multiplan Commercial |
$19.21
|
| Rate for Payer: Networks By Design Commercial |
$16.65
|
| Rate for Payer: Prime Health Services Commercial |
$21.78
|
|
|
HC SOM SEROTONIN BLOOD
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$225.34 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$30.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$225.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.73
|
| 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 |
$46.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.82
|
| Rate for Payer: EPIC Health Plan Senior |
$30.98
|
| 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 |
$50.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$30.98
|
| Rate for Payer: InnovAge PACE Commercial |
$46.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.51
|
| 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 |
$30.98
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$32.84
|
| Rate for Payer: Riverside University Health System MISP |
$34.08
|
| 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 |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Upland Medical Group Pediatric |
$30.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.08
|
| Rate for Payer: Vantage Medical Group Senior |
$30.98
|
|
|
HC SOM SEROTONIN BLOOD
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
900911033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC SOM SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900915358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900915358
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.55
|
| Rate for Payer: Blue Shield of California Commercial |
$212.45
|
| Rate for Payer: Blue Shield of California EPN |
$138.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.52
|
| Rate for Payer: EPIC Health Plan Senior |
$24.09
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: InnovAge PACE Commercial |
$36.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC SOM SEX HORMN BINDNG GLOBU SER
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
900913804
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$158.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.07
|
| Rate for Payer: Blue Shield of California Commercial |
$7.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.16
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.34
|
| Rate for Payer: EPIC Health Plan Senior |
$21.73
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.73
|
| Rate for Payer: InnovAge PACE Commercial |
$32.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.12
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.73
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Medicare |
$23.03
|
| Rate for Payer: Riverside University Health System MISP |
$23.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.60
|
| Rate for Payer: United Healthcare All Other HMO |
$17.60
|
| Rate for Payer: United Healthcare HMO Rider |
$17.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.60
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.90
|
| Rate for Payer: Vantage Medical Group Senior |
$21.73
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$619.56 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$137.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$619.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.74
|
| Rate for Payer: Blue Shield of California Commercial |
$121.40
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.95
|
| Rate for Payer: EPIC Health Plan Senior |
$137.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$224.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.00
|
| Rate for Payer: InnovAge PACE Commercial |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$183.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$183.58
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$137.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$145.22
|
| Rate for Payer: Riverside University Health System MISP |
$150.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.97
|
| Rate for Payer: United Healthcare All Other HMO |
$110.97
|
| Rate for Payer: United Healthcare HMO Rider |
$110.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$137.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.00
|
|
|
HC SOM SMA CARRIER BY DEL/DUP
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 81329
|
| Hospital Charge Code |
900915323
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
OP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$23.56 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.78
|
| Rate for Payer: Blue Shield of California Commercial |
$10.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.72
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Central Health Plan Commercial |
$13.54
|
| Rate for Payer: Cigna of CA HMO |
$10.84
|
| Rate for Payer: Cigna of CA PPO |
$12.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$12.05
|
| Rate for Payer: Galaxy Health WC |
$14.39
|
| Rate for Payer: Global Benefits Group Commercial |
$10.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.05
|
| Rate for Payer: InnovAge PACE Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.39
|
| Rate for Payer: Prime Health Services Medicare |
$12.77
|
| Rate for Payer: Riverside University Health System MISP |
$13.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Vantage Medical Group Senior |
$12.05
|
|
|
HC SOM SMOOTH MUSCLE AB TITER REFLEX
|
Facility
|
IP
|
$16.93
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
900915437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$15.24 |
| Rate for Payer: Adventist Health Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Central Health Plan Commercial |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.77
|
| Rate for Payer: EPIC Health Plan Senior |
$6.77
|
| Rate for Payer: Galaxy Health WC |
$14.39
|
| Rate for Payer: Global Benefits Group Commercial |
$10.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.39
|
| Rate for Payer: Multiplan Commercial |
$12.70
|
| Rate for Payer: Networks By Design Commercial |
$11.00
|
| Rate for Payer: Prime Health Services Commercial |
$14.39
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Senior |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC SOM SOMATOSTATIN
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 84307
|
| Hospital Charge Code |
900911327
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Adventist Health Commercial |
$49.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.12
|
| Rate for Payer: Blue Shield of California Commercial |
$148.72
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.68
|
| Rate for Payer: EPIC Health Plan Senior |
$18.28
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.28
|
| Rate for Payer: InnovAge PACE Commercial |
$27.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.50
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.28
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Prime Health Services Medicare |
$19.38
|
| Rate for Payer: Riverside University Health System MISP |
$20.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.80
|
| Rate for Payer: United Healthcare All Other HMO |
$14.80
|
| Rate for Payer: United Healthcare HMO Rider |
$14.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Vantage Medical Group Senior |
$18.28
|
|
|
HC SOM SOTALOL
|
Facility
|
IP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$74.01 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Central Health Plan Commercial |
$65.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.89
|
| Rate for Payer: EPIC Health Plan Senior |
$32.89
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.45
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
|
|
HC SOM SOTALOL
|
Facility
|
OP
|
$82.23
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900910789
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$105.94 |
| Rate for Payer: Adventist Health Commercial |
$16.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.50
|
| Rate for Payer: Blue Shield of California Commercial |
$49.91
|
| Rate for Payer: Blue Shield of California EPN |
$32.65
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Cash Price |
$82.23
|
| Rate for Payer: Central Health Plan Commercial |
$65.78
|
| Rate for Payer: Cigna of CA HMO |
$52.63
|
| Rate for Payer: Cigna of CA PPO |
$60.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$69.90
|
| Rate for Payer: Global Benefits Group Commercial |
$49.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$61.67
|
| Rate for Payer: Networks By Design Commercial |
$53.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$69.90
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$37.52 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.61
|
| Rate for Payer: Blue Shield of California Commercial |
$21.85
|
| Rate for Payer: Blue Shield of California EPN |
$14.29
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.90
|
| Rate for Payer: EPIC Health Plan Senior |
$15.48
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$25.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.48
|
| Rate for Payer: InnovAge PACE Commercial |
$23.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.48
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$16.41
|
| Rate for Payer: Riverside University Health System MISP |
$17.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.54
|
| Rate for Payer: United Healthcare All Other HMO |
$12.54
|
| Rate for Payer: United Healthcare HMO Rider |
$12.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.03
|
| Rate for Payer: Vantage Medical Group Senior |
$15.48
|
|
|
HC SOM SPCL HC COAG INTERPRETATION
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
900913972
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC SOM SPN 87206
|
Facility
|
OP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.93
|
| Rate for Payer: Blue Shield of California Commercial |
$29.55
|
| Rate for Payer: Blue Shield of California EPN |
$19.33
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Central Health Plan Commercial |
$38.94
|
| Rate for Payer: Cigna of CA HMO |
$31.16
|
| Rate for Payer: Cigna of CA PPO |
$36.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$41.38
|
| Rate for Payer: Global Benefits Group Commercial |
$29.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.81
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: InnovAge PACE Commercial |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$36.51
|
| Rate for Payer: Networks By Design Commercial |
$31.64
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.39
|
| Rate for Payer: Prime Health Services Commercial |
$41.38
|
| Rate for Payer: Prime Health Services Medicare |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$5.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Other HMO |
$4.37
|
| Rate for Payer: United Healthcare HMO Rider |
$4.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC SOM SPN 87206
|
Facility
|
IP
|
$48.68
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900914919
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Adventist Health Commercial |
$9.74
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Central Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.47
|
| Rate for Payer: EPIC Health Plan Senior |
$19.47
|
| Rate for Payer: Galaxy Health WC |
$41.38
|
| Rate for Payer: Global Benefits Group Commercial |
$29.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.74
|
| Rate for Payer: Multiplan Commercial |
$36.51
|
| Rate for Payer: Networks By Design Commercial |
$31.64
|
| Rate for Payer: Prime Health Services Commercial |
$41.38
|
|
|
HC SOM SSDNA 86226
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86226
|
| Hospital Charge Code |
900914817
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$88.11 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.88
|
| Rate for Payer: Blue Shield of California Commercial |
$33.38
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Senior |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: InnovAge PACE Commercial |
$18.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.11
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Medicare |
$12.84
|
| Rate for Payer: Riverside University Health System MISP |
$13.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.81
|
| Rate for Payer: United Healthcare All Other HMO |
$9.81
|
| Rate for Payer: United Healthcare HMO Rider |
$9.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
