|
HC SOM CERULOPLASMIN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC SOM CERULOPLASMIN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
900915329
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$108.60 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.97
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| 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 |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.72
|
| Rate for Payer: EPIC Health Plan Senior |
$11.81
|
| 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 |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.39
|
| 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 |
$10.74
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$11.38
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| 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 |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM CHESTNUT IGE
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914685
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| 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 |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| 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 |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| 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 SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Central Health Plan Commercial |
$53.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.56
|
| Rate for Payer: EPIC Health Plan Senior |
$26.56
|
| Rate for Payer: Galaxy Health WC |
$56.45
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: Prime Health Services Commercial |
$56.45
|
|
|
HC SOM CHLORDIAZEPOXIDE (LIBRIUM)
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
900911081
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Adventist Health Commercial |
$13.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| 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 |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$41.84
|
| Rate for Payer: Blue Shield of California EPN |
$26.36
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Cash Price |
$66.41
|
| Rate for Payer: Central Health Plan Commercial |
$53.13
|
| Rate for Payer: Cigna of CA HMO |
$42.50
|
| Rate for Payer: Cigna of CA PPO |
$49.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| Rate for Payer: Galaxy Health WC |
$56.45
|
| Rate for Payer: Global Benefits Group Commercial |
$39.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.77
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$49.81
|
| Rate for Payer: Networks By Design Commercial |
$43.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$56.45
|
| 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 |
$39.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.85
|
| 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 CHLORIDE BF
|
Facility
|
OP
|
$7.01
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900914683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$49.43 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.43
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$5.61
|
| Rate for Payer: Cigna of CA HMO |
$4.49
|
| Rate for Payer: Cigna of CA PPO |
$5.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.50
|
| Rate for Payer: Galaxy Health WC |
$5.96
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.96
|
| Rate for Payer: Prime Health Services Medicare |
$5.30
|
| Rate for Payer: Riverside University Health System MISP |
$5.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
|
|
HC SOM CHLORIDE BF
|
Facility
|
IP
|
$7.01
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900914683
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$6.31 |
| Rate for Payer: Adventist Health Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Central Health Plan Commercial |
$5.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2.80
|
| Rate for Payer: Galaxy Health WC |
$5.96
|
| Rate for Payer: Global Benefits Group Commercial |
$4.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$5.26
|
| Rate for Payer: Networks By Design Commercial |
$4.56
|
| Rate for Payer: Prime Health Services Commercial |
$5.96
|
|
|
HC SOM CHOLESTEROL BF
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.75
|
| Rate for Payer: Blue Shield of California Commercial |
$103.95
|
| Rate for Payer: Blue Shield of California EPN |
$65.50
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.37
|
| Rate for Payer: EPIC Health Plan Senior |
$8.91
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.10
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC SOM CHOLESTEROL BF
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
IP
|
$24.12
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$21.71 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Central Health Plan Commercial |
$19.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.65
|
| Rate for Payer: EPIC Health Plan Senior |
$9.65
|
| Rate for Payer: Galaxy Health WC |
$20.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$18.09
|
| Rate for Payer: Networks By Design Commercial |
$15.68
|
| Rate for Payer: Prime Health Services Commercial |
$20.50
|
|
|
HC SOM CHOLINESTERASE PSEUDO
|
Facility
|
OP
|
$24.12
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
900911160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$79.67 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$7.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.67
|
| Rate for Payer: Blue Shield of California Commercial |
$15.20
|
| Rate for Payer: Blue Shield of California EPN |
$9.58
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Cash Price |
$24.12
|
| Rate for Payer: Central Health Plan Commercial |
$19.30
|
| Rate for Payer: Cigna of CA HMO |
$15.44
|
| Rate for Payer: Cigna of CA PPO |
$17.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.66
|
| Rate for Payer: Galaxy Health WC |
$20.50
|
| Rate for Payer: Global Benefits Group Commercial |
$14.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.71
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$18.09
|
| Rate for Payer: Networks By Design Commercial |
$15.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7.87
|
| Rate for Payer: Prime Health Services Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.34
|
| Rate for Payer: Riverside University Health System MISP |
$8.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.37
|
| Rate for Payer: United Healthcare All Other HMO |
$6.37
|
| Rate for Payer: United Healthcare HMO Rider |
$6.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.37
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Vantage Medical Group Senior |
$7.87
|
|
|
HC SOM CHRAF CULTURE 03
|
Facility
|
OP
|
$137.52
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$1,116.68 |
| Rate for Payer: Adventist Health Commercial |
$27.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,116.68
|
| Rate for Payer: Blue Shield of California Commercial |
$86.64
|
| Rate for Payer: Blue Shield of California EPN |
$54.60
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Central Health Plan Commercial |
$110.02
|
| Rate for Payer: Cigna of CA HMO |
$88.01
|
| Rate for Payer: Cigna of CA PPO |
$101.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: Galaxy Health WC |
$116.89
|
| Rate for Payer: Global Benefits Group Commercial |
$82.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$103.14
|
| Rate for Payer: Networks By Design Commercial |
$89.39
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: Prime Health Services Commercial |
$116.89
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Riverside University Health System MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRAF CULTURE 03
|
Facility
|
IP
|
$137.52
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915285
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Adventist Health Commercial |
$27.50
|
| Rate for Payer: Cash Price |
$137.52
|
| Rate for Payer: Central Health Plan Commercial |
$110.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.01
|
| Rate for Payer: EPIC Health Plan Senior |
$55.01
|
| Rate for Payer: Galaxy Health WC |
$116.89
|
| Rate for Payer: Global Benefits Group Commercial |
$82.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$103.14
|
| Rate for Payer: Networks By Design Commercial |
$89.39
|
| Rate for Payer: Prime Health Services Commercial |
$116.89
|
|
|
HC SOM CHRBM CULTURE 04
|
Facility
|
IP
|
$101.87
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$91.68 |
| Rate for Payer: Adventist Health Commercial |
$20.37
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Central Health Plan Commercial |
$81.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.75
|
| Rate for Payer: EPIC Health Plan Senior |
$40.75
|
| Rate for Payer: Galaxy Health WC |
$86.59
|
| Rate for Payer: Global Benefits Group Commercial |
$61.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$60.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Multiplan Commercial |
$76.40
|
| Rate for Payer: Networks By Design Commercial |
$66.22
|
| Rate for Payer: Prime Health Services Commercial |
$86.59
|
|
|
HC SOM CHRBM CULTURE 04
|
Facility
|
OP
|
$101.87
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915318
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$1,084.47 |
| Rate for Payer: Adventist Health Commercial |
$20.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.47
|
| Rate for Payer: Blue Shield of California Commercial |
$64.18
|
| Rate for Payer: Blue Shield of California EPN |
$40.44
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Cash Price |
$101.87
|
| Rate for Payer: Central Health Plan Commercial |
$81.50
|
| Rate for Payer: Cigna of CA HMO |
$65.20
|
| Rate for Payer: Cigna of CA PPO |
$75.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$71.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: Galaxy Health WC |
$86.59
|
| Rate for Payer: Global Benefits Group Commercial |
$61.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.68
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$76.40
|
| Rate for Payer: Networks By Design Commercial |
$66.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.75
|
| Rate for Payer: Prime Health Services Commercial |
$86.59
|
| Rate for Payer: Prime Health Services Medicare |
$152.38
|
| Rate for Payer: Riverside University Health System MISP |
$158.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
|
IP
|
$89.11
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$80.20 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Central Health Plan Commercial |
$71.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.64
|
| Rate for Payer: EPIC Health Plan Senior |
$35.64
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
|
|
HC SOM CHRCB CULTURE 01
|
Facility
|
OP
|
$89.11
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
900915319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$1,000.31 |
| Rate for Payer: Adventist Health Commercial |
$17.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$116.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$719.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,000.31
|
| Rate for Payer: Blue Shield of California Commercial |
$56.14
|
| Rate for Payer: Blue Shield of California EPN |
$35.38
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Cash Price |
$89.11
|
| Rate for Payer: Central Health Plan Commercial |
$71.29
|
| Rate for Payer: Cigna of CA HMO |
$57.03
|
| Rate for Payer: Cigna of CA PPO |
$65.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.21
|
| Rate for Payer: EPIC Health Plan Senior |
$128.14
|
| Rate for Payer: Galaxy Health WC |
$75.74
|
| Rate for Payer: Global Benefits Group Commercial |
$53.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$191.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$156.10
|
| Rate for Payer: Multiplan Commercial |
$66.83
|
| Rate for Payer: Networks By Design Commercial |
$57.92
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$116.49
|
| Rate for Payer: Prime Health Services Commercial |
$75.74
|
| Rate for Payer: Prime Health Services Medicare |
$123.48
|
| Rate for Payer: Riverside University Health System MISP |
$128.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.36
|
| Rate for Payer: United Healthcare All Other HMO |
$94.36
|
| Rate for Payer: United Healthcare HMO Rider |
$94.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$116.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$174.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.14
|
| Rate for Payer: Vantage Medical Group Senior |
$116.49
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
|
IP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$319.05 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Central Health Plan Commercial |
$283.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$248.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.80
|
| Rate for Payer: EPIC Health Plan Senior |
$141.80
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$225.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$209.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.90
|
| Rate for Payer: Multiplan Commercial |
$265.88
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
|
|
HC SOM CHRCV CULTURE 03
|
Facility
|
OP
|
$354.50
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
900915316
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.90 |
| Max. Negotiated Rate |
$1,116.68 |
| Rate for Payer: Adventist Health Commercial |
$70.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$150.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$803.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,116.68
|
| Rate for Payer: Blue Shield of California Commercial |
$223.34
|
| Rate for Payer: Blue Shield of California EPN |
$140.74
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Cash Price |
$354.50
|
| Rate for Payer: Central Health Plan Commercial |
$283.60
|
| Rate for Payer: Cigna of CA HMO |
$226.88
|
| Rate for Payer: Cigna of CA PPO |
$262.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$248.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$165.33
|
| Rate for Payer: Galaxy Health WC |
$301.32
|
| Rate for Payer: Global Benefits Group Commercial |
$212.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$319.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$246.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$150.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$225.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.40
|
| Rate for Payer: Multiplan Commercial |
$265.88
|
| Rate for Payer: Networks By Design Commercial |
$230.43
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$150.30
|
| Rate for Payer: Prime Health Services Commercial |
$301.32
|
| Rate for Payer: Prime Health Services Medicare |
$159.32
|
| Rate for Payer: Riverside University Health System MISP |
$165.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.74
|
| Rate for Payer: United Healthcare All Other HMO |
$121.74
|
| Rate for Payer: United Healthcare HMO Rider |
$121.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.74
|
| Rate for Payer: Upland Medical Group Pediatric |
$150.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.33
|
| Rate for Payer: Vantage Medical Group Senior |
$150.30
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
IP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$143.39 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Central Health Plan Commercial |
$127.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.73
|
| Rate for Payer: EPIC Health Plan Senior |
$63.73
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$94.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.86
|
| Rate for Payer: Multiplan Commercial |
$119.49
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
|
|
HC SOM CHRHB CULTURE 04
|
Facility
|
OP
|
$159.32
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
900915287
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$1,084.47 |
| Rate for Payer: Adventist Health Commercial |
$31.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$143.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$926.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$780.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,084.47
|
| Rate for Payer: Blue Shield of California Commercial |
$100.37
|
| Rate for Payer: Blue Shield of California EPN |
$63.25
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Cash Price |
$159.32
|
| Rate for Payer: Central Health Plan Commercial |
$127.46
|
| Rate for Payer: Cigna of CA HMO |
$101.96
|
| Rate for Payer: Cigna of CA PPO |
$117.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$143.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.19
|
| Rate for Payer: EPIC Health Plan Senior |
$158.12
|
| Rate for Payer: Galaxy Health WC |
$135.42
|
| Rate for Payer: Global Benefits Group Commercial |
$95.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.39
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$235.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$171.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$143.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$101.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$201.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.62
|
| Rate for Payer: Multiplan Commercial |
$119.49
|
| Rate for Payer: Networks By Design Commercial |
$103.56
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$143.75
|
| Rate for Payer: Prime Health Services Commercial |
$135.42
|
| Rate for Payer: Prime Health Services Medicare |
$152.38
|
| Rate for Payer: Riverside University Health System MISP |
$158.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.44
|
| Rate for Payer: United Healthcare All Other HMO |
$116.44
|
| Rate for Payer: United Healthcare HMO Rider |
$116.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$143.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.12
|
| Rate for Payer: Vantage Medical Group Senior |
$143.75
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
IP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$160.60 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Central Health Plan Commercial |
$142.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.38
|
| Rate for Payer: EPIC Health Plan Senior |
$71.38
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.69
|
| Rate for Payer: Multiplan Commercial |
$133.83
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
|
|
HC SOM CHRLN CULTURE 04
|
Facility
|
OP
|
$178.44
|
|
|
Service Code
|
CPT 88239
|
| Hospital Charge Code |
900915317
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$1,443.78 |
| Rate for Payer: Adventist Health Commercial |
$35.69
|
| Rate for Payer: Adventist Health Medi-Cal |
$147.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,082.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,038.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,443.78
|
| Rate for Payer: Blue Shield of California Commercial |
$112.42
|
| Rate for Payer: Blue Shield of California EPN |
$70.84
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Cash Price |
$178.44
|
| Rate for Payer: Central Health Plan Commercial |
$142.75
|
| Rate for Payer: Cigna of CA HMO |
$114.20
|
| Rate for Payer: Cigna of CA PPO |
$132.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$147.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.41
|
| Rate for Payer: EPIC Health Plan Senior |
$162.27
|
| Rate for Payer: Galaxy Health WC |
$151.67
|
| Rate for Payer: Global Benefits Group Commercial |
$107.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$241.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$225.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$147.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$197.68
|
| Rate for Payer: Multiplan Commercial |
$133.83
|
| Rate for Payer: Networks By Design Commercial |
$115.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$147.52
|
| Rate for Payer: Prime Health Services Commercial |
$151.67
|
| Rate for Payer: Prime Health Services Medicare |
$156.37
|
| Rate for Payer: Riverside University Health System MISP |
$162.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$119.49
|
| Rate for Payer: United Healthcare All Other HMO |
$119.49
|
| Rate for Payer: United Healthcare HMO Rider |
$119.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$147.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.27
|
| Rate for Payer: Vantage Medical Group Senior |
$147.52
|
|
|
HC SOM CHROMIUM
|
Facility
|
OP
|
$26.11
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
900911190
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$205.09 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.09
|
| Rate for Payer: Blue Shield of California Commercial |
$16.45
|
| Rate for Payer: Blue Shield of California EPN |
$10.37
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Central Health Plan Commercial |
$20.89
|
| Rate for Payer: Cigna of CA HMO |
$16.71
|
| Rate for Payer: Cigna of CA PPO |
$19.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.46
|
| Rate for Payer: EPIC Health Plan Senior |
$22.31
|
| Rate for Payer: Galaxy Health WC |
$22.19
|
| Rate for Payer: Global Benefits Group Commercial |
$15.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.18
|
| Rate for Payer: Multiplan Commercial |
$19.58
|
| Rate for Payer: Networks By Design Commercial |
$16.97
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.28
|
| Rate for Payer: Prime Health Services Commercial |
$22.19
|
| Rate for Payer: Prime Health Services Medicare |
$21.50
|
| Rate for Payer: Riverside University Health System MISP |
$22.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.43
|
| Rate for Payer: United Healthcare All Other HMO |
$16.43
|
| Rate for Payer: United Healthcare HMO Rider |
$16.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.31
|
| Rate for Payer: Vantage Medical Group Senior |
$20.28
|
|
