|
HC SOM FMGA 84181
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.00
|
| Rate for Payer: EPIC Health Plan Senior |
$50.00
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
|
|
HC SOM FMGA 84181
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
900914770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$172.27 |
| Rate for Payer: Adventist Health Commercial |
$25.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.27
|
| Rate for Payer: Blue Shield of California Commercial |
$78.75
|
| Rate for Payer: Blue Shield of California EPN |
$49.62
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Central Health Plan Commercial |
$100.00
|
| Rate for Payer: Cigna of CA HMO |
$80.00
|
| Rate for Payer: Cigna of CA PPO |
$92.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$106.25
|
| Rate for Payer: Global Benefits Group Commercial |
$75.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$93.75
|
| Rate for Payer: Networks By Design Commercial |
$81.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.03
|
| Rate for Payer: Prime Health Services Commercial |
$106.25
|
| Rate for Payer: Prime Health Services Medicare |
$18.05
|
| Rate for Payer: Riverside University Health System MISP |
$18.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.80
|
| Rate for Payer: United Healthcare All Other HMO |
$13.80
|
| Rate for Payer: United Healthcare HMO Rider |
$13.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.73
|
| Rate for Payer: Vantage Medical Group Senior |
$17.03
|
|
|
HC SOM FMGS 83520A
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMGS 83520A
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914771
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM FMGS 83520B
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC SOM FMGS 83520B
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914772
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$130.94 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$69.30
|
| Rate for Payer: Blue Shield of California EPN |
$43.67
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMIS 83520
|
Facility
|
OP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$159.96 |
| Rate for Payer: Adventist Health Commercial |
$35.55
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.94
|
| Rate for Payer: Blue Shield of California Commercial |
$111.97
|
| Rate for Payer: Blue Shield of California EPN |
$70.56
|
| Rate for Payer: Cash Price |
$177.73
|
| Rate for Payer: Cash Price |
$177.73
|
| Rate for Payer: Central Health Plan Commercial |
$142.18
|
| Rate for Payer: Cigna of CA HMO |
$113.75
|
| Rate for Payer: Cigna of CA PPO |
$131.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$151.07
|
| Rate for Payer: Global Benefits Group Commercial |
$106.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.96
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$133.30
|
| Rate for Payer: Networks By Design Commercial |
$115.52
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$151.07
|
| Rate for Payer: Prime Health Services Medicare |
$18.31
|
| Rate for Payer: Riverside University Health System MISP |
$19.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.99
|
| Rate for Payer: United Healthcare All Other HMO |
$13.99
|
| Rate for Payer: United Healthcare HMO Rider |
$13.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.27
|
|
|
HC SOM FMIS 83520
|
Facility
|
IP
|
$177.73
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900914924
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$159.96 |
| Rate for Payer: Adventist Health Commercial |
$35.55
|
| Rate for Payer: Cash Price |
$177.73
|
| Rate for Payer: Central Health Plan Commercial |
$142.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.09
|
| Rate for Payer: EPIC Health Plan Senior |
$71.09
|
| Rate for Payer: Galaxy Health WC |
$151.07
|
| Rate for Payer: Global Benefits Group Commercial |
$106.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.55
|
| Rate for Payer: Multiplan Commercial |
$133.30
|
| Rate for Payer: Networks By Design Commercial |
$115.52
|
| Rate for Payer: Prime Health Services Commercial |
$151.07
|
|
|
HC SOM FNTSM
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| 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 |
$110.25
|
| Rate for Payer: Blue Shield of California EPN |
$69.47
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| 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 |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| 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 |
$111.12
|
| 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 |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| 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 |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914870
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FNTSM 82492A
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| 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 |
$110.25
|
| Rate for Payer: Blue Shield of California EPN |
$69.47
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| 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 |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| 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 |
$111.12
|
| 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 |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| 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 |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492A
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914868
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FNTSM 82492B
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| 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 |
$110.25
|
| Rate for Payer: Blue Shield of California EPN |
$69.47
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| 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 |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| 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 |
$111.12
|
| 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 |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| 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 |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.51
|
| Rate for Payer: United Healthcare All Other HMO |
$19.51
|
| Rate for Payer: United Healthcare HMO Rider |
$19.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.50
|
| Rate for Payer: Vantage Medical Group Senior |
$24.09
|
|
|
HC SOM FNTSM 82492B
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914869
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC SOM FOLATE, RBC
|
Facility
|
OP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.60
|
| Rate for Payer: Blue Shield of California Commercial |
$33.08
|
| Rate for Payer: Blue Shield of California EPN |
$20.84
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Central Health Plan Commercial |
$42.00
|
| Rate for Payer: Cigna of CA HMO |
$33.60
|
| Rate for Payer: Cigna of CA PPO |
$38.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.41
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$39.38
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.65
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
| Rate for Payer: Prime Health Services Medicare |
$18.71
|
| Rate for Payer: Riverside University Health System MISP |
$19.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.30
|
| Rate for Payer: United Healthcare All Other HMO |
$14.30
|
| Rate for Payer: United Healthcare HMO Rider |
$14.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.30
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.41
|
| Rate for Payer: Vantage Medical Group Senior |
$17.65
|
|
|
HC SOM FOLATE, RBC
|
Facility
|
IP
|
$52.50
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
900913862
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Adventist Health Commercial |
$10.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Central Health Plan Commercial |
$42.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.00
|
| Rate for Payer: EPIC Health Plan Senior |
$21.00
|
| Rate for Payer: Galaxy Health WC |
$44.62
|
| Rate for Payer: Global Benefits Group Commercial |
$31.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$39.38
|
| Rate for Payer: Networks By Design Commercial |
$34.12
|
| Rate for Payer: Prime Health Services Commercial |
$44.62
|
|
|
HC SOM FPRSG 84150
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| 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 FPRSG 84150
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
900914777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.83 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$41.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.41
|
| 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 |
$62.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.92
|
| Rate for Payer: EPIC Health Plan Senior |
$45.95
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$68.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$41.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.97
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$41.77
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Prime Health Services Medicare |
$44.28
|
| Rate for Payer: Riverside University Health System MISP |
$45.95
|
| 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 |
$33.83
|
| Rate for Payer: United Healthcare All Other HMO |
$33.83
|
| Rate for Payer: United Healthcare HMO Rider |
$33.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$41.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.95
|
| Rate for Payer: Vantage Medical Group Senior |
$41.77
|
|
|
HC SOM FPSAP 84153
|
Facility
|
IP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$80.55 |
| Rate for Payer: Adventist Health Commercial |
$17.90
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Central Health Plan Commercial |
$71.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.80
|
| Rate for Payer: EPIC Health Plan Senior |
$35.80
|
| Rate for Payer: Galaxy Health WC |
$76.08
|
| Rate for Payer: Global Benefits Group Commercial |
$53.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.90
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: Networks By Design Commercial |
$58.17
|
| Rate for Payer: Prime Health Services Commercial |
$76.08
|
|
|
HC SOM FPSAP 84153
|
Facility
|
OP
|
$89.50
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900914765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$186.02 |
| Rate for Payer: Adventist Health Commercial |
$17.90
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.02
|
| Rate for Payer: Blue Shield of California Commercial |
$56.38
|
| Rate for Payer: Blue Shield of California EPN |
$35.53
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Central Health Plan Commercial |
$71.60
|
| Rate for Payer: Cigna of CA HMO |
$57.28
|
| Rate for Payer: Cigna of CA PPO |
$66.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.23
|
| Rate for Payer: Galaxy Health WC |
$76.08
|
| Rate for Payer: Global Benefits Group Commercial |
$53.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$67.12
|
| Rate for Payer: Networks By Design Commercial |
$58.17
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$76.08
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC SOM FQUET 82491
|
Facility
|
IP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$59.54 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Central Health Plan Commercial |
$52.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.46
|
| Rate for Payer: EPIC Health Plan Senior |
$26.46
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.23
|
| Rate for Payer: Multiplan Commercial |
$49.62
|
| Rate for Payer: Networks By Design Commercial |
$43.00
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
|
|
HC SOM FQUET 82491
|
Facility
|
OP
|
$66.16
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
900914892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$181.87 |
| Rate for Payer: Adventist Health Commercial |
$13.23
|
| 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 |
$41.68
|
| Rate for Payer: Blue Shield of California EPN |
$26.27
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Cash Price |
$66.16
|
| Rate for Payer: Central Health Plan Commercial |
$52.93
|
| Rate for Payer: Cigna of CA HMO |
$42.34
|
| Rate for Payer: Cigna of CA PPO |
$48.96
|
| 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 |
$46.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.75
|
| Rate for Payer: EPIC Health Plan Senior |
$26.50
|
| Rate for Payer: Galaxy Health WC |
$56.24
|
| Rate for Payer: Global Benefits Group Commercial |
$39.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.54
|
| 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 |
$42.01
|
| 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 |
$13.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.28
|
| Rate for Payer: Multiplan Commercial |
$49.62
|
| Rate for Payer: Networks By Design Commercial |
$43.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$24.09
|
| Rate for Payer: Prime Health Services Commercial |
$56.24
|
| 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 |
$39.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.70
|
| 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 FRAGILE X FU ANALYSIS
|
Facility
|
IP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$194.85 |
| Rate for Payer: Adventist Health Commercial |
$43.30
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Central Health Plan Commercial |
$173.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.60
|
| Rate for Payer: EPIC Health Plan Senior |
$86.60
|
| Rate for Payer: Galaxy Health WC |
$184.03
|
| Rate for Payer: Global Benefits Group Commercial |
$129.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.30
|
| Rate for Payer: Multiplan Commercial |
$162.38
|
| Rate for Payer: Networks By Design Commercial |
$140.72
|
| Rate for Payer: Prime Health Services Commercial |
$184.03
|
|
|
HC SOM FRAGILE X FU ANALYSIS
|
Facility
|
OP
|
$216.50
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
900915280
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$198.82 |
| Rate for Payer: Adventist Health Commercial |
$43.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$44.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$143.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.82
|
| Rate for Payer: Blue Shield of California Commercial |
$136.40
|
| Rate for Payer: Blue Shield of California EPN |
$85.95
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Central Health Plan Commercial |
$173.20
|
| Rate for Payer: Cigna of CA HMO |
$138.56
|
| Rate for Payer: Cigna of CA PPO |
$160.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$49.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.07
|
| Rate for Payer: EPIC Health Plan Senior |
$49.38
|
| Rate for Payer: Galaxy Health WC |
$184.03
|
| Rate for Payer: Global Benefits Group Commercial |
$129.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.85
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$73.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$44.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$162.38
|
| Rate for Payer: Networks By Design Commercial |
$140.72
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$44.89
|
| Rate for Payer: Prime Health Services Commercial |
$184.03
|
| Rate for Payer: Prime Health Services Medicare |
$47.58
|
| Rate for Payer: Riverside University Health System MISP |
$49.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.36
|
| Rate for Payer: United Healthcare All Other HMO |
$36.36
|
| Rate for Payer: United Healthcare HMO Rider |
$36.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$44.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.38
|
| Rate for Payer: Vantage Medical Group Senior |
$44.89
|
|
|
HC SOM FRAGILE X MOLECULAR ANALYSIS
|
Facility
|
OP
|
$299.72
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
900912503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Adventist Health Commercial |
$59.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$57.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$356.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$494.95
|
| Rate for Payer: Blue Shield of California Commercial |
$188.82
|
| Rate for Payer: Blue Shield of California EPN |
$118.99
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Cash Price |
$299.72
|
| Rate for Payer: Central Health Plan Commercial |
$239.78
|
| Rate for Payer: Cigna of CA HMO |
$191.82
|
| Rate for Payer: Cigna of CA PPO |
$221.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$209.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.12
|
| Rate for Payer: EPIC Health Plan Senior |
$62.74
|
| Rate for Payer: Galaxy Health WC |
$254.76
|
| Rate for Payer: Global Benefits Group Commercial |
$179.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$269.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$93.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$57.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$86.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$76.43
|
| Rate for Payer: Multiplan Commercial |
$224.79
|
| Rate for Payer: Networks By Design Commercial |
$194.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$57.04
|
| Rate for Payer: Prime Health Services Commercial |
$254.76
|
| Rate for Payer: Prime Health Services Medicare |
$60.46
|
| Rate for Payer: Riverside University Health System MISP |
$62.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$179.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$179.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.21
|
| Rate for Payer: United Healthcare All Other HMO |
$46.21
|
| Rate for Payer: United Healthcare HMO Rider |
$46.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$57.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.74
|
| Rate for Payer: Vantage Medical Group Senior |
$57.04
|
|
