|
HC SOM FBP1 88273
|
Facility
|
IP
|
$84.86
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900914874
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$76.37 |
| Rate for Payer: Adventist Health Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Central Health Plan Commercial |
$67.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.94
|
| Rate for Payer: EPIC Health Plan Senior |
$33.94
|
| Rate for Payer: Galaxy Health WC |
$72.13
|
| Rate for Payer: Global Benefits Group Commercial |
$50.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.97
|
| Rate for Payer: Multiplan Commercial |
$63.65
|
| Rate for Payer: Networks By Design Commercial |
$55.16
|
| Rate for Payer: Prime Health Services Commercial |
$72.13
|
|
|
HC SOM FBP1 88291
|
Facility
|
IP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$64.03 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Central Health Plan Commercial |
$56.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.23
|
| Rate for Payer: Multiplan Commercial |
$53.36
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
|
|
HC SOM FBP1 88291
|
Facility
|
OP
|
$71.15
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914873
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$188.95 |
| Rate for Payer: Adventist Health Commercial |
$14.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.95
|
| Rate for Payer: Blue Shield of California Commercial |
$44.82
|
| Rate for Payer: Blue Shield of California EPN |
$28.25
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Cash Price |
$71.15
|
| Rate for Payer: Central Health Plan Commercial |
$56.92
|
| Rate for Payer: Cigna of CA HMO |
$45.54
|
| Rate for Payer: Cigna of CA PPO |
$52.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.46
|
| Rate for Payer: EPIC Health Plan Senior |
$28.46
|
| Rate for Payer: Galaxy Health WC |
$60.48
|
| Rate for Payer: Global Benefits Group Commercial |
$42.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$53.36
|
| Rate for Payer: Networks By Design Commercial |
$46.25
|
| Rate for Payer: Prime Health Services Commercial |
$60.48
|
| Rate for Payer: Riverside University Health System MISP |
$28.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.19
|
| Rate for Payer: United Healthcare All Other HMO |
$27.19
|
| Rate for Payer: United Healthcare HMO Rider |
$27.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.48
|
| Rate for Payer: Vantage Medical Group Senior |
$60.48
|
|
|
HC SOM FCFQN 86171
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC SOM FCFQN 86171
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86171
|
| Hospital Charge Code |
900914248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$101.32 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.32
|
| Rate for Payer: Blue Shield of California Commercial |
$42.21
|
| Rate for Payer: Blue Shield of California EPN |
$26.60
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Cash Price |
$67.00
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.52
|
| Rate for Payer: EPIC Health Plan Senior |
$11.01
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.41
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.01
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Prime Health Services Medicare |
$10.61
|
| Rate for Payer: Riverside University Health System MISP |
$11.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.11
|
| Rate for Payer: United Healthcare All Other HMO |
$8.11
|
| Rate for Payer: United Healthcare HMO Rider |
$8.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.01
|
| Rate for Payer: Vantage Medical Group Senior |
$10.01
|
|
|
HC SOM FCTRC 87110
|
Facility
|
IP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Central Health Plan Commercial |
$55.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.83
|
| Rate for Payer: EPIC Health Plan Senior |
$27.83
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.91
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
|
|
HC SOM FCTRC 87110
|
Facility
|
OP
|
$69.57
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
900914725
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$198.21 |
| Rate for Payer: Adventist Health Commercial |
$13.91
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.21
|
| Rate for Payer: Blue Shield of California Commercial |
$43.83
|
| Rate for Payer: Blue Shield of California EPN |
$27.62
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Cash Price |
$69.57
|
| Rate for Payer: Central Health Plan Commercial |
$55.66
|
| Rate for Payer: Cigna of CA HMO |
$44.52
|
| Rate for Payer: Cigna of CA PPO |
$51.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.34
|
| Rate for Payer: EPIC Health Plan Senior |
$21.56
|
| Rate for Payer: Galaxy Health WC |
$59.13
|
| Rate for Payer: Global Benefits Group Commercial |
$41.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$52.18
|
| Rate for Payer: Networks By Design Commercial |
$45.22
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.60
|
| Rate for Payer: Prime Health Services Commercial |
$59.13
|
| Rate for Payer: Prime Health Services Medicare |
$20.78
|
| Rate for Payer: Riverside University Health System MISP |
$21.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.88
|
| Rate for Payer: United Healthcare All Other HMO |
$15.88
|
| Rate for Payer: United Healthcare HMO Rider |
$15.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Vantage Medical Group Senior |
$19.60
|
|
|
HC SOM FCTRC 87140
|
Facility
|
OP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.45
|
| Rate for Payer: Blue Shield of California Commercial |
$12.48
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.85
|
| Rate for Payer: Cigna of CA HMO |
$12.68
|
| Rate for Payer: Cigna of CA PPO |
$14.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.19
|
| Rate for Payer: EPIC Health Plan Senior |
$6.13
|
| Rate for Payer: Galaxy Health WC |
$16.84
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.83
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.57
|
| Rate for Payer: Prime Health Services Commercial |
$16.84
|
| Rate for Payer: Prime Health Services Medicare |
$5.90
|
| Rate for Payer: Riverside University Health System MISP |
$6.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC SOM FCTRC 87140
|
Facility
|
IP
|
$19.81
|
|
|
Service Code
|
CPT 87140
|
| Hospital Charge Code |
900914726
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$17.83 |
| Rate for Payer: Adventist Health Commercial |
$3.96
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$15.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.92
|
| Rate for Payer: EPIC Health Plan Senior |
$7.92
|
| Rate for Payer: Galaxy Health WC |
$16.84
|
| Rate for Payer: Global Benefits Group Commercial |
$11.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$14.86
|
| Rate for Payer: Networks By Design Commercial |
$12.88
|
| Rate for Payer: Prime Health Services Commercial |
$16.84
|
|
|
HC SOM FDSAC 82657
|
Facility
|
OP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$106.42
|
| Rate for Payer: Blue Shield of California EPN |
$67.06
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Central Health Plan Commercial |
$135.14
|
| Rate for Payer: Cigna of CA HMO |
$108.11
|
| Rate for Payer: Cigna of CA PPO |
$125.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.58
|
| Rate for Payer: EPIC Health Plan Senior |
$24.39
|
| Rate for Payer: Galaxy Health WC |
$143.58
|
| Rate for Payer: Global Benefits Group Commercial |
$101.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.71
|
| Rate for Payer: Multiplan Commercial |
$126.69
|
| Rate for Payer: Networks By Design Commercial |
$109.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.17
|
| Rate for Payer: Prime Health Services Commercial |
$143.58
|
| Rate for Payer: Prime Health Services Medicare |
$23.50
|
| Rate for Payer: Riverside University Health System MISP |
$24.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC SOM FDSAC 82657
|
Facility
|
IP
|
$168.92
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
900914885
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.78 |
| Max. Negotiated Rate |
$152.03 |
| Rate for Payer: Adventist Health Commercial |
$33.78
|
| Rate for Payer: Cash Price |
$168.92
|
| Rate for Payer: Central Health Plan Commercial |
$135.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.57
|
| Rate for Payer: EPIC Health Plan Senior |
$67.57
|
| Rate for Payer: Galaxy Health WC |
$143.58
|
| Rate for Payer: Global Benefits Group Commercial |
$101.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.78
|
| Rate for Payer: Multiplan Commercial |
$126.69
|
| Rate for Payer: Networks By Design Commercial |
$109.80
|
| Rate for Payer: Prime Health Services Commercial |
$143.58
|
|
|
HC SOM FDXM 82542
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: EPIC Health Plan Senior |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC SOM FDXM 82542
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$20.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$63.63
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: Cigna of CA HMO |
$64.64
|
| Rate for Payer: Cigna of CA PPO |
$74.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$64.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
| Rate for Payer: Prime Health Services Medicare |
$25.54
|
| Rate for Payer: Riverside University Health System MISP |
$26.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FEAGR 86682
|
Facility
|
OP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$132.78 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.78
|
| Rate for Payer: Blue Shield of California Commercial |
$33.12
|
| Rate for Payer: Blue Shield of California EPN |
$20.87
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Central Health Plan Commercial |
$42.06
|
| Rate for Payer: Cigna of CA HMO |
$33.64
|
| Rate for Payer: Cigna of CA PPO |
$38.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.47
|
| Rate for Payer: EPIC Health Plan Senior |
$14.31
|
| Rate for Payer: Galaxy Health WC |
$44.68
|
| Rate for Payer: Global Benefits Group Commercial |
$31.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$39.43
|
| Rate for Payer: Networks By Design Commercial |
$34.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.01
|
| Rate for Payer: Prime Health Services Commercial |
$44.68
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Riverside University Health System MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOM FEAGR 86682
|
Facility
|
IP
|
$52.57
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$47.31 |
| Rate for Payer: Adventist Health Commercial |
$10.51
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Central Health Plan Commercial |
$42.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.03
|
| Rate for Payer: EPIC Health Plan Senior |
$21.03
|
| Rate for Payer: Galaxy Health WC |
$44.68
|
| Rate for Payer: Global Benefits Group Commercial |
$31.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$39.43
|
| Rate for Payer: Networks By Design Commercial |
$34.17
|
| Rate for Payer: Prime Health Services Commercial |
$44.68
|
|
|
HC SOM FELBAMATE S
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| 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 SOM FELBAMATE S
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 80167
|
| Hospital Charge Code |
900914198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$97.19 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| 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 |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.73
|
| Rate for Payer: Blue Shield of California Commercial |
$15.75
|
| Rate for Payer: Blue Shield of California EPN |
$9.93
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| 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 |
$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 |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.76
|
| Rate for Payer: EPIC Health Plan Senior |
$20.50
|
| 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 |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.98
|
| 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 |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| 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 |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| 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 FENTU
|
Facility
|
OP
|
$49.50
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$188.75 |
| Rate for Payer: Adventist Health Commercial |
$9.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.75
|
| Rate for Payer: Blue Shield of California Commercial |
$31.18
|
| Rate for Payer: Blue Shield of California EPN |
$19.65
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$31.68
|
| Rate for Payer: Cigna of CA PPO |
$36.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.80
|
| Rate for Payer: Galaxy Health WC |
$42.08
|
| Rate for Payer: Global Benefits Group Commercial |
$29.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$34.65
|
| Rate for Payer: Multiplan Commercial |
$37.12
|
| Rate for Payer: Networks By Design Commercial |
$32.17
|
| Rate for Payer: Prime Health Services Commercial |
$42.08
|
| Rate for Payer: Riverside University Health System MISP |
$19.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.75
|
| Rate for Payer: United Healthcare All Other HMO |
$24.75
|
| Rate for Payer: United Healthcare HMO Rider |
$24.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.08
|
| Rate for Payer: Vantage Medical Group Senior |
$42.08
|
|
|
HC SOM FENTU
|
Facility
|
IP
|
$49.50
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
900915270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$44.55 |
| Rate for Payer: Adventist Health Commercial |
$9.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$39.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.80
|
| Rate for Payer: EPIC Health Plan Senior |
$19.80
|
| Rate for Payer: Galaxy Health WC |
$42.08
|
| Rate for Payer: Global Benefits Group Commercial |
$29.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.90
|
| Rate for Payer: Multiplan Commercial |
$37.12
|
| Rate for Payer: Networks By Design Commercial |
$32.17
|
| Rate for Payer: Prime Health Services Commercial |
$42.08
|
|
|
HC SOM FESC 83789
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Senior |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC SOM FESC 83789
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
900914814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$24.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.87
|
| Rate for Payer: Blue Shield of California Commercial |
$85.68
|
| Rate for Payer: Blue Shield of California EPN |
$53.99
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Central Health Plan Commercial |
$108.80
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.78
|
| Rate for Payer: EPIC Health Plan Senior |
$26.52
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$122.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$39.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$102.00
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.11
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Medicare |
$25.56
|
| Rate for Payer: Riverside University Health System MISP |
$26.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.53
|
| Rate for Payer: United Healthcare All Other HMO |
$19.53
|
| Rate for Payer: United Healthcare HMO Rider |
$19.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC SOM FFTP 86780
|
Facility
|
IP
|
$28.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914768
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$25.74 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.44
|
| Rate for Payer: EPIC Health Plan Senior |
$11.44
|
| Rate for Payer: Galaxy Health WC |
$24.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
| Rate for Payer: Networks By Design Commercial |
$18.59
|
| Rate for Payer: Prime Health Services Commercial |
$24.31
|
|
|
HC SOM FFTP 86780
|
Facility
|
OP
|
$28.60
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900914768
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$175.47 |
| Rate for Payer: Adventist Health Commercial |
$5.72
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.47
|
| Rate for Payer: Blue Shield of California Commercial |
$18.02
|
| Rate for Payer: Blue Shield of California EPN |
$11.35
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.88
|
| Rate for Payer: Cigna of CA HMO |
$18.30
|
| Rate for Payer: Cigna of CA PPO |
$21.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.85
|
| Rate for Payer: EPIC Health Plan Senior |
$14.56
|
| Rate for Payer: Galaxy Health WC |
$24.31
|
| Rate for Payer: Global Benefits Group Commercial |
$17.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$21.45
|
| Rate for Payer: Networks By Design Commercial |
$18.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.24
|
| Rate for Payer: Prime Health Services Commercial |
$24.31
|
| Rate for Payer: Prime Health Services Medicare |
$14.03
|
| Rate for Payer: Riverside University Health System MISP |
$14.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SOM FHBG 87912
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
900914883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$2,061.15 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$257.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,845.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$257.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,482.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,061.15
|
| Rate for Payer: Blue Shield of California Commercial |
$236.25
|
| Rate for Payer: Blue Shield of California EPN |
$148.88
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: Cigna of CA HMO |
$240.00
|
| Rate for Payer: Cigna of CA PPO |
$277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$257.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$262.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.79
|
| Rate for Payer: EPIC Health Plan Senior |
$283.19
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$422.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$257.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$44.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$360.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.98
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$257.45
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
| Rate for Payer: Prime Health Services Medicare |
$272.90
|
| Rate for Payer: Riverside University Health System MISP |
$283.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.54
|
| Rate for Payer: United Healthcare All Other HMO |
$208.54
|
| Rate for Payer: United Healthcare HMO Rider |
$208.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$257.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$386.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.19
|
| Rate for Payer: Vantage Medical Group Senior |
$257.45
|
|
|
HC SOM FHBG 87912
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
900914883
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Adventist Health Commercial |
$75.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Central Health Plan Commercial |
$300.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$262.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.00
|
| Rate for Payer: EPIC Health Plan Senior |
$150.00
|
| Rate for Payer: Galaxy Health WC |
$318.75
|
| Rate for Payer: Global Benefits Group Commercial |
$225.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$221.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$281.25
|
| Rate for Payer: Networks By Design Commercial |
$243.75
|
| Rate for Payer: Prime Health Services Commercial |
$318.75
|
|
