|
HC SOSB MICRO ARTHROPOD EXAM
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
900915252
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6.07
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: InnovAge PACE Commercial |
$6.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.27
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Riverside University Health System MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SO SNGL SHLDR ELASTIC PREFAB
|
Facility
|
OP
|
$118.00
|
|
| Hospital Charge Code |
905353651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$71.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.30
|
| Rate for Payer: Blue Shield of California Commercial |
$72.10
|
| Rate for Payer: Blue Shield of California EPN |
$47.08
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$75.52
|
| Rate for Payer: Cigna of CA PPO |
$87.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Senior |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: InnovAge PACE Commercial |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.60
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Riverside University Health System MISP |
$47.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.00
|
| Rate for Payer: United Healthcare All Other HMO |
$59.00
|
| Rate for Payer: United Healthcare HMO Rider |
$59.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC SO SNGL SHLDR ELASTIC PREFAB
|
Facility
|
IP
|
$118.00
|
|
| Hospital Charge Code |
905353651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Cash Price |
$118.00
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Senior |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$73.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC SOSPH MTB PCR SPUTUM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$41.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$60.70
|
| Rate for Payer: Blue Shield of California EPN |
$39.70
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.27
|
| Rate for Payer: EPIC Health Plan Senior |
$41.68
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.68
|
| Rate for Payer: InnovAge PACE Commercial |
$62.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$55.85
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41.68
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Medicare |
$44.18
|
| Rate for Payer: Riverside University Health System MISP |
$45.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.76
|
| Rate for Payer: United Healthcare All Other HMO |
$33.76
|
| Rate for Payer: United Healthcare HMO Rider |
$33.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.76
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.85
|
| Rate for Payer: Vantage Medical Group Senior |
$41.68
|
|
|
HC SOSPH MTB PCR SPUTUM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
900915436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC SOSTL ABPA ALLERG SP IGE
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914779
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOSTL ABPA ALLERG SP IGE
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914779
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care 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 |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| 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 |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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: Upland Medical Group Pediatric |
$5.22
|
| 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 SOSTL ABPA ALLERG SP IGG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900914780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$38.01 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Shield of California Commercial |
$15.18
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.82
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOSTL ABPA ALLERG SP IGG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900914780
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC SOSTL ABPA INTERP
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
900914782
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$31.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Shield of California Commercial |
$30.35
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: InnovAge PACE Commercial |
$46.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$31.12
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$32.99
|
| Rate for Payer: Riverside University Health System MISP |
$34.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC SOSTL ABPA INTERP
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
900914782
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC SOSTL ABPA PRECIP AB
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914781
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.69
|
| Rate for Payer: Blue Shield of California Commercial |
$127.47
|
| Rate for Payer: Blue Shield of California EPN |
$83.37
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOSTL ABPA PRECIP AB
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914781
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC SOSTL ABPA TOTAL IGE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900914778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$119.80 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.31
|
| Rate for Payer: Blue Shield of California Commercial |
$45.52
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.22
|
| Rate for Payer: EPIC Health Plan Senior |
$16.46
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.46
|
| Rate for Payer: InnovAge PACE Commercial |
$24.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.06
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.46
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$17.45
|
| Rate for Payer: Riverside University Health System MISP |
$18.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.33
|
| Rate for Payer: United Healthcare All Other HMO |
$13.33
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.33
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.11
|
| Rate for Payer: Vantage Medical Group Senior |
$16.46
|
|
|
HC SOSTL ABPA TOTAL IGE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
900914778
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC SOUCI METHOTREXATE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 80229
|
| Hospital Charge Code |
900915251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.30
|
| 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 |
$30.25
|
| 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 |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| 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: InnovAge PACE Commercial |
$27.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Riverside University Health System MISP |
$22.00
|
| 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 |
$27.50
|
| Rate for Payer: United Healthcare All Other HMO |
$27.50
|
| Rate for Payer: United Healthcare HMO Rider |
$27.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC SOUCI METHOTREXATE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 80229
|
| Hospital Charge Code |
900915251
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$30.25
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC SOUMN OCA1 81479
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$1,223.10 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,087.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.60
|
| Rate for Payer: EPIC Health Plan Senior |
$543.60
|
| Rate for Payer: Galaxy Health WC |
$1,155.15
|
| Rate for Payer: Global Benefits Group Commercial |
$815.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,223.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$906.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.80
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: Networks By Design Commercial |
$883.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,155.15
|
|
|
HC SOUMN OCA1 81479
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914802
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$1,223.10 |
| Rate for Payer: Adventist Health Commercial |
$271.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$825.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$747.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,019.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$658.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$798.14
|
| Rate for Payer: Blue Shield of California Commercial |
$824.91
|
| Rate for Payer: Blue Shield of California EPN |
$539.52
|
| Rate for Payer: Cash Price |
$747.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,087.20
|
| Rate for Payer: Cigna of CA HMO |
$869.76
|
| Rate for Payer: Cigna of CA PPO |
$1,005.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,155.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,155.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$543.60
|
| Rate for Payer: EPIC Health Plan Senior |
$543.60
|
| Rate for Payer: Galaxy Health WC |
$1,155.15
|
| Rate for Payer: Global Benefits Group Commercial |
$815.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,223.10
|
| Rate for Payer: InnovAge PACE Commercial |
$679.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$906.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$841.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$951.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$951.30
|
| Rate for Payer: Multiplan Commercial |
$1,019.25
|
| Rate for Payer: Networks By Design Commercial |
$883.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,155.15
|
| Rate for Payer: Riverside University Health System MISP |
$543.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$815.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$815.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$679.50
|
| Rate for Payer: United Healthcare All Other HMO |
$679.50
|
| Rate for Payer: United Healthcare HMO Rider |
$679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$679.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,155.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,155.15
|
|
|
HC SOUOC NSD1 DEL/DUP
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 81407
|
| Hospital Charge Code |
900914719
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC SOUOC NSD1 DEL/DUP
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 81407
|
| Hospital Charge Code |
900914719
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$14,098.08 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$846.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$318.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$930.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$846.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14,098.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,861.24
|
| Rate for Payer: Blue Shield of California Commercial |
$318.68
|
| Rate for Payer: Blue Shield of California EPN |
$208.43
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Cash Price |
$288.75
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$388.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$846.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.46
|
| Rate for Payer: EPIC Health Plan Senior |
$846.27
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,387.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,455.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$846.27
|
| Rate for Payer: InnovAge PACE Commercial |
$1,269.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,607.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$846.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$846.27
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Prime Health Services Medicare |
$897.05
|
| Rate for Payer: Riverside University Health System MISP |
$930.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$685.48
|
| Rate for Payer: United Healthcare All Other HMO |
$685.48
|
| Rate for Payer: United Healthcare HMO Rider |
$685.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$685.48
|
| Rate for Payer: Upland Medical Group Pediatric |
$846.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,269.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.90
|
| Rate for Payer: Vantage Medical Group Senior |
$846.27
|
|
|
HC SOUOC NSD1 SEQ
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914718
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$923.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,576.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
|
|
HC SOUOC NSD1 SEQ
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914718
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$229.13 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Adventist Health Commercial |
$485.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$282.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,472.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,748.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,471.97
|
| Rate for Payer: Blue Shield of California EPN |
$962.73
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Cash Price |
$1,333.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,552.00
|
| Rate for Payer: Cigna of CA PPO |
$1,794.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.89
|
| Rate for Payer: EPIC Health Plan Senior |
$282.88
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$486.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$282.88
|
| Rate for Payer: InnovAge PACE Commercial |
$424.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,617.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,576.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$282.88
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: Prime Health Services Medicare |
$299.85
|
| Rate for Payer: Riverside University Health System MISP |
$311.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$282.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 1
|
Facility
|
OP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915332
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$38.01 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.71
|
| Rate for Payer: Blue Shield of California Commercial |
$11.64
|
| Rate for Payer: Blue Shield of California EPN |
$7.61
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Central Health Plan Commercial |
$15.34
|
| Rate for Payer: Cigna of CA HMO |
$12.27
|
| Rate for Payer: Cigna of CA PPO |
$14.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.56
|
| Rate for Payer: EPIC Health Plan Senior |
$7.82
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.82
|
| Rate for Payer: InnovAge PACE Commercial |
$11.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.48
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.82
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
| Rate for Payer: Prime Health Services Medicare |
$8.29
|
| Rate for Payer: Riverside University Health System MISP |
$8.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.34
|
| Rate for Payer: United Healthcare All Other HMO |
$6.34
|
| Rate for Payer: United Healthcare HMO Rider |
$6.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.60
|
| Rate for Payer: Vantage Medical Group Senior |
$7.82
|
|
|
HC SOV HYPERSENSITIVITY PNEUMONITIS PAN 1
|
Facility
|
IP
|
$19.17
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
900915332
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Adventist Health Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$10.54
|
| Rate for Payer: Central Health Plan Commercial |
$15.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.67
|
| Rate for Payer: EPIC Health Plan Senior |
$7.67
|
| Rate for Payer: Galaxy Health WC |
$16.29
|
| Rate for Payer: Global Benefits Group Commercial |
$11.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$14.38
|
| Rate for Payer: Networks By Design Commercial |
$12.46
|
| Rate for Payer: Prime Health Services Commercial |
$16.29
|
|
