|
HC SOM FHSII 86696
|
Facility
|
IP
|
$37.37
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$33.63 |
| Rate for Payer: Adventist Health Commercial |
$7.47
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Central Health Plan Commercial |
$29.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.95
|
| Rate for Payer: EPIC Health Plan Senior |
$14.95
|
| Rate for Payer: Galaxy Health WC |
$31.76
|
| Rate for Payer: Global Benefits Group Commercial |
$22.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Multiplan Commercial |
$28.03
|
| Rate for Payer: Networks By Design Commercial |
$24.29
|
| Rate for Payer: Prime Health Services Commercial |
$31.76
|
|
|
HC SOM FHSII 86696
|
Facility
|
OP
|
$37.37
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900914757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$195.62 |
| Rate for Payer: Adventist Health Commercial |
$7.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$19.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$195.62
|
| Rate for Payer: Blue Shield of California Commercial |
$23.54
|
| Rate for Payer: Blue Shield of California EPN |
$14.84
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Central Health Plan Commercial |
$29.90
|
| Rate for Payer: Cigna of CA HMO |
$23.92
|
| Rate for Payer: Cigna of CA PPO |
$27.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.93
|
| Rate for Payer: EPIC Health Plan Senior |
$21.29
|
| Rate for Payer: Galaxy Health WC |
$31.76
|
| Rate for Payer: Global Benefits Group Commercial |
$22.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.63
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$28.03
|
| Rate for Payer: Networks By Design Commercial |
$24.29
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$19.35
|
| Rate for Payer: Prime Health Services Commercial |
$31.76
|
| Rate for Payer: Prime Health Services Medicare |
$20.51
|
| Rate for Payer: Riverside University Health System MISP |
$21.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC SOM FHTL 87798A
|
Facility
|
OP
|
$112.81
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$71.07
|
| Rate for Payer: Blue Shield of California EPN |
$44.79
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Central Health Plan Commercial |
$90.25
|
| Rate for Payer: Cigna of CA HMO |
$72.20
|
| Rate for Payer: Cigna of CA PPO |
$83.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$95.89
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$95.89
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM FHTL 87798A
|
Facility
|
IP
|
$112.81
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$101.53 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Cash Price |
$112.81
|
| Rate for Payer: Central Health Plan Commercial |
$90.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.12
|
| Rate for Payer: EPIC Health Plan Senior |
$45.12
|
| Rate for Payer: Galaxy Health WC |
$95.89
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: Prime Health Services Commercial |
$95.89
|
|
|
HC SOM FHTL 87798B
|
Facility
|
IP
|
$112.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$101.54 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Central Health Plan Commercial |
$90.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.13
|
| Rate for Payer: EPIC Health Plan Senior |
$45.13
|
| Rate for Payer: Galaxy Health WC |
$95.90
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: Prime Health Services Commercial |
$95.90
|
|
|
HC SOM FHTL 87798B
|
Facility
|
OP
|
$112.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914746
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.56 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$22.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$71.08
|
| Rate for Payer: Blue Shield of California EPN |
$44.79
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Cash Price |
$112.82
|
| Rate for Payer: Central Health Plan Commercial |
$90.26
|
| Rate for Payer: Cigna of CA HMO |
$72.20
|
| Rate for Payer: Cigna of CA PPO |
$83.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$95.90
|
| Rate for Payer: Global Benefits Group Commercial |
$67.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$84.61
|
| Rate for Payer: Networks By Design Commercial |
$73.33
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$95.90
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC SOM FIAIA 82397
|
Facility
|
IP
|
$186.25
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$167.62 |
| Rate for Payer: Adventist Health Commercial |
$37.25
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Central Health Plan Commercial |
$149.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.50
|
| Rate for Payer: EPIC Health Plan Senior |
$74.50
|
| Rate for Payer: Galaxy Health WC |
$158.31
|
| Rate for Payer: Global Benefits Group Commercial |
$111.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$109.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Multiplan Commercial |
$139.69
|
| Rate for Payer: Networks By Design Commercial |
$121.06
|
| Rate for Payer: Prime Health Services Commercial |
$158.31
|
|
|
HC SOM FIAIA 82397
|
Facility
|
OP
|
$186.25
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
900915258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$167.62 |
| Rate for Payer: Adventist Health Commercial |
$37.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.92
|
| Rate for Payer: Blue Shield of California Commercial |
$117.34
|
| Rate for Payer: Blue Shield of California EPN |
$73.94
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Central Health Plan Commercial |
$149.00
|
| Rate for Payer: Cigna of CA HMO |
$119.20
|
| Rate for Payer: Cigna of CA PPO |
$137.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.30
|
| Rate for Payer: EPIC Health Plan Senior |
$15.53
|
| Rate for Payer: Galaxy Health WC |
$158.31
|
| Rate for Payer: Global Benefits Group Commercial |
$111.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$167.62
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.92
|
| Rate for Payer: Multiplan Commercial |
$139.69
|
| Rate for Payer: Networks By Design Commercial |
$121.06
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.12
|
| Rate for Payer: Prime Health Services Commercial |
$158.31
|
| Rate for Payer: Prime Health Services Medicare |
$14.97
|
| Rate for Payer: Riverside University Health System MISP |
$15.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.44
|
| Rate for Payer: United Healthcare All Other HMO |
$11.44
|
| Rate for Payer: United Healthcare HMO Rider |
$11.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.53
|
| Rate for Payer: Vantage Medical Group Senior |
$14.12
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
|
OP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$1,208.26 |
| Rate for Payer: Adventist Health Commercial |
$38.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$140.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,032.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$869.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,208.26
|
| Rate for Payer: Blue Shield of California Commercial |
$122.52
|
| Rate for Payer: Blue Shield of California EPN |
$77.21
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Central Health Plan Commercial |
$155.58
|
| Rate for Payer: Cigna of CA HMO |
$124.47
|
| Rate for Payer: Cigna of CA PPO |
$143.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.20
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$165.31
|
| Rate for Payer: Global Benefits Group Commercial |
$116.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.03
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$230.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$215.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$140.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$188.58
|
| Rate for Payer: Multiplan Commercial |
$145.86
|
| Rate for Payer: Networks By Design Commercial |
$126.41
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$140.73
|
| Rate for Payer: Prime Health Services Commercial |
$165.31
|
| Rate for Payer: Prime Health Services Medicare |
$149.17
|
| Rate for Payer: Riverside University Health System MISP |
$154.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.99
|
| Rate for Payer: United Healthcare All Other HMO |
$113.99
|
| Rate for Payer: United Healthcare HMO Rider |
$113.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$140.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.80
|
| Rate for Payer: Vantage Medical Group Senior |
$140.73
|
|
|
HC SOM FIBRO CULT FOR GENE TEST
|
Facility
|
IP
|
$194.48
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
900915284
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$175.03 |
| Rate for Payer: Adventist Health Commercial |
$38.90
|
| Rate for Payer: Cash Price |
$194.48
|
| Rate for Payer: Central Health Plan Commercial |
$155.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.79
|
| Rate for Payer: EPIC Health Plan Senior |
$77.79
|
| Rate for Payer: Galaxy Health WC |
$165.31
|
| Rate for Payer: Global Benefits Group Commercial |
$116.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.90
|
| Rate for Payer: Multiplan Commercial |
$145.86
|
| Rate for Payer: Networks By Design Commercial |
$126.41
|
| Rate for Payer: Prime Health Services Commercial |
$165.31
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8.79
|
| Rate for Payer: Blue Shield of California EPN |
$5.54
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$11.16
|
| Rate for Payer: Cigna of CA HMO |
$8.93
|
| Rate for Payer: Cigna of CA PPO |
$10.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.57
|
| Rate for Payer: EPIC Health Plan Senior |
$14.38
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.51
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
| Rate for Payer: Prime Health Services Medicare |
$13.85
|
| Rate for Payer: Riverside University Health System MISP |
$14.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.58
|
| Rate for Payer: United Healthcare All Other HMO |
$10.58
|
| Rate for Payer: United Healthcare HMO Rider |
$10.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.07
|
|
|
HC SOM FIBRO CULT GENE TEST CRYO
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
CPT 88240
|
| Hospital Charge Code |
900915290
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Adventist Health Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$11.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.58
|
| Rate for Payer: EPIC Health Plan Senior |
$5.58
|
| Rate for Payer: Galaxy Health WC |
$11.86
|
| Rate for Payer: Global Benefits Group Commercial |
$8.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$10.46
|
| Rate for Payer: Networks By Design Commercial |
$9.07
|
| Rate for Payer: Prime Health Services Commercial |
$11.86
|
|
|
HC SOM FIDQL 86331
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC SOM FIDQL 86331
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
900914249
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$121.20 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$37.17
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SOM FINA 86382
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: EPIC Health Plan Senior |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC SOM FINA 86382
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
900914730
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.56
|
| Rate for Payer: Blue Shield of California Commercial |
$247.59
|
| Rate for Payer: Blue Shield of California EPN |
$156.02
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.90
|
| Rate for Payer: EPIC Health Plan Senior |
$18.60
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.66
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.91
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| Rate for Payer: Prime Health Services Medicare |
$17.92
|
| Rate for Payer: Riverside University Health System MISP |
$18.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.70
|
| Rate for Payer: United Healthcare All Other HMO |
$13.70
|
| Rate for Payer: United Healthcare HMO Rider |
$13.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.60
|
| Rate for Payer: Vantage Medical Group Senior |
$16.91
|
|
|
HC SOM FINA 87253
|
Facility
|
OP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$422.31 |
| Rate for Payer: Adventist Health Commercial |
$93.85
|
| Rate for Payer: Adventist Health Medi-Cal |
$20.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.86
|
| Rate for Payer: Blue Shield of California Commercial |
$295.61
|
| Rate for Payer: Blue Shield of California EPN |
$186.28
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Central Health Plan Commercial |
$375.38
|
| Rate for Payer: Cigna of CA HMO |
$300.31
|
| Rate for Payer: Cigna of CA PPO |
$347.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.33
|
| Rate for Payer: EPIC Health Plan Senior |
$22.22
|
| Rate for Payer: Galaxy Health WC |
$398.85
|
| Rate for Payer: Global Benefits Group Commercial |
$281.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.07
|
| Rate for Payer: Multiplan Commercial |
$351.92
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$20.20
|
| Rate for Payer: Prime Health Services Commercial |
$398.85
|
| Rate for Payer: Prime Health Services Medicare |
$21.41
|
| Rate for Payer: Riverside University Health System MISP |
$22.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.36
|
| Rate for Payer: United Healthcare All Other HMO |
$16.36
|
| Rate for Payer: United Healthcare HMO Rider |
$16.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.22
|
| Rate for Payer: Vantage Medical Group Senior |
$20.20
|
|
|
HC SOM FINA 87253
|
Facility
|
IP
|
$469.23
|
|
|
Service Code
|
CPT 87253
|
| Hospital Charge Code |
900914731
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$93.85 |
| Max. Negotiated Rate |
$422.31 |
| Rate for Payer: Adventist Health Commercial |
$93.85
|
| Rate for Payer: Cash Price |
$469.23
|
| Rate for Payer: Central Health Plan Commercial |
$375.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.69
|
| Rate for Payer: EPIC Health Plan Senior |
$187.69
|
| Rate for Payer: Galaxy Health WC |
$398.85
|
| Rate for Payer: Global Benefits Group Commercial |
$281.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.85
|
| Rate for Payer: Multiplan Commercial |
$351.92
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$398.85
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| 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 |
$220.50
|
| Rate for Payer: Blue Shield of California EPN |
$138.95
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC SOM FISH AML LOCUS ANOMALIES
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912611
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SOM FISH B ALL
|
Facility
|
IP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$153.27 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Central Health Plan Commercial |
$136.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: EPIC Health Plan Senior |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.75
|
| Rate for Payer: Global Benefits Group Commercial |
$102.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: Networks By Design Commercial |
$110.69
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
|
|
HC SOM FISH B ALL
|
Facility
|
OP
|
$170.30
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900912609
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$188.95 |
| Rate for Payer: Adventist Health Commercial |
$34.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.72
|
| 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 |
$107.29
|
| Rate for Payer: Blue Shield of California EPN |
$67.61
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Central Health Plan Commercial |
$136.24
|
| Rate for Payer: Cigna of CA HMO |
$108.99
|
| Rate for Payer: Cigna of CA PPO |
$126.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.12
|
| Rate for Payer: EPIC Health Plan Senior |
$68.12
|
| Rate for Payer: Galaxy Health WC |
$144.75
|
| Rate for Payer: Global Benefits Group Commercial |
$102.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$127.72
|
| Rate for Payer: Networks By Design Commercial |
$110.69
|
| Rate for Payer: Prime Health Services Commercial |
$144.75
|
| Rate for Payer: Riverside University Health System MISP |
$68.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.18
|
| 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 |
$144.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.75
|
| Rate for Payer: Vantage Medical Group Senior |
$144.75
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
IP
|
$203.22
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$182.90 |
| Rate for Payer: Adventist Health Commercial |
$40.64
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Central Health Plan Commercial |
$162.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.29
|
| Rate for Payer: EPIC Health Plan Senior |
$81.29
|
| Rate for Payer: Galaxy Health WC |
$172.74
|
| Rate for Payer: Global Benefits Group Commercial |
$121.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.64
|
| Rate for Payer: Multiplan Commercial |
$152.41
|
| Rate for Payer: Networks By Design Commercial |
$132.09
|
| Rate for Payer: Prime Health Services Commercial |
$172.74
|
|
|
HC SOM FISH DIGEORGE VELO-CARDIO-FACL
|
Facility
|
OP
|
$203.22
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910684
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$188.95 |
| Rate for Payer: Adventist Health Commercial |
$40.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$172.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$111.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.41
|
| 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 |
$128.03
|
| Rate for Payer: Blue Shield of California EPN |
$80.68
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Cash Price |
$203.22
|
| Rate for Payer: Central Health Plan Commercial |
$162.58
|
| Rate for Payer: Cigna of CA HMO |
$130.06
|
| Rate for Payer: Cigna of CA PPO |
$150.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$172.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$172.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$142.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.29
|
| Rate for Payer: EPIC Health Plan Senior |
$81.29
|
| Rate for Payer: Galaxy Health WC |
$172.74
|
| Rate for Payer: Global Benefits Group Commercial |
$121.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$182.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$129.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$119.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$142.25
|
| Rate for Payer: Multiplan Commercial |
$152.41
|
| Rate for Payer: Networks By Design Commercial |
$132.09
|
| Rate for Payer: Prime Health Services Commercial |
$172.74
|
| Rate for Payer: Riverside University Health System MISP |
$81.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.93
|
| 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 |
$172.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$172.74
|
| Rate for Payer: Vantage Medical Group Senior |
$172.74
|
|
|
HC SOM FISH FOR CLL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900910707
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
