|
HC SOM LYME DISEASE AB IGM
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
900912696
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC SOM LYME DISEASE AB SERUM
|
Facility
|
OP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$162.94 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| 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 |
$117.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.94
|
| Rate for Payer: Blue Shield of California Commercial |
$10.27
|
| Rate for Payer: Blue Shield of California EPN |
$6.47
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Central Health Plan Commercial |
$13.04
|
| Rate for Payer: Cigna of CA HMO |
$10.43
|
| Rate for Payer: Cigna of CA PPO |
$12.06
|
| 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 |
$11.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.10
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.67
|
| 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 |
$10.35
|
| 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 |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.82
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.03
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
| 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 |
$9.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.78
|
| 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 LYME DISEASE AB SERUM
|
Facility
|
IP
|
$16.30
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
900912568
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$14.67 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$16.30
|
| Rate for Payer: Central Health Plan Commercial |
$13.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.52
|
| Rate for Payer: EPIC Health Plan Senior |
$6.52
|
| Rate for Payer: Galaxy Health WC |
$13.86
|
| Rate for Payer: Global Benefits Group Commercial |
$9.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: Networks By Design Commercial |
$10.60
|
| Rate for Payer: Prime Health Services Commercial |
$13.86
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$151.64 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$110.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.64
|
| Rate for Payer: Blue Shield of California Commercial |
$81.90
|
| Rate for Payer: Blue Shield of California EPN |
$51.61
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.73
|
| Rate for Payer: EPIC Health Plan Senior |
$16.49
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.99
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Medicare |
$15.89
|
| Rate for Payer: Riverside University Health System MISP |
$16.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.14
|
| Rate for Payer: United Healthcare All Other HMO |
$12.14
|
| Rate for Payer: United Healthcare HMO Rider |
$12.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.49
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC SOM LYME SERUM AND CSF ANAL
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
900914676
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC SOM LYSO 86003
|
Facility
|
IP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$6.72 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.99
|
| Rate for Payer: EPIC Health Plan Senior |
$2.99
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
|
|
HC SOM LYSO 86003
|
Facility
|
OP
|
$7.47
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900914738
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$1.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$4.71
|
| Rate for Payer: Blue Shield of California EPN |
$2.97
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$4.78
|
| Rate for Payer: Cigna of CA PPO |
$5.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$6.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.72
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Networks By Design Commercial |
$4.86
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$6.35
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
|
OP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$67.34 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4.67
|
| Rate for Payer: Blue Shield of California EPN |
$2.94
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Central Health Plan Commercial |
$5.93
|
| Rate for Payer: Cigna of CA HMO |
$4.74
|
| Rate for Payer: Cigna of CA PPO |
$5.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$6.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.70
|
| Rate for Payer: Prime Health Services Commercial |
$6.30
|
| Rate for Payer: Prime Health Services Medicare |
$7.10
|
| Rate for Payer: Riverside University Health System MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MAGNESIUM RANDOM UR
|
Facility
|
IP
|
$7.41
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900913941
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Adventist Health Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Central Health Plan Commercial |
$5.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.96
|
| Rate for Payer: EPIC Health Plan Senior |
$2.96
|
| Rate for Payer: Galaxy Health WC |
$6.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$5.56
|
| Rate for Payer: Networks By Design Commercial |
$4.82
|
| Rate for Payer: Prime Health Services Commercial |
$6.30
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
|
IP
|
$25.03
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Adventist Health Commercial |
$5.01
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Central Health Plan Commercial |
$20.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.01
|
| Rate for Payer: EPIC Health Plan Senior |
$10.01
|
| Rate for Payer: Galaxy Health WC |
$21.28
|
| Rate for Payer: Global Benefits Group Commercial |
$15.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: Multiplan Commercial |
$18.77
|
| Rate for Payer: Networks By Design Commercial |
$16.27
|
| Rate for Payer: Prime Health Services Commercial |
$21.28
|
|
|
HC SOM MAGNESIUM, URINE
|
Facility
|
OP
|
$25.03
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
900910757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$67.34 |
| Rate for Payer: Adventist Health Commercial |
$5.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.34
|
| Rate for Payer: Blue Shield of California Commercial |
$15.77
|
| Rate for Payer: Blue Shield of California EPN |
$9.94
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Central Health Plan Commercial |
$20.02
|
| Rate for Payer: Cigna of CA HMO |
$16.02
|
| Rate for Payer: Cigna of CA PPO |
$18.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.37
|
| Rate for Payer: Galaxy Health WC |
$21.28
|
| Rate for Payer: Global Benefits Group Commercial |
$15.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.53
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.98
|
| Rate for Payer: Multiplan Commercial |
$18.77
|
| Rate for Payer: Networks By Design Commercial |
$16.27
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.70
|
| Rate for Payer: Prime Health Services Commercial |
$21.28
|
| Rate for Payer: Prime Health Services Medicare |
$7.10
|
| Rate for Payer: Riverside University Health System MISP |
$7.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.43
|
| Rate for Payer: United Healthcare All Other HMO |
$5.43
|
| Rate for Payer: United Healthcare HMO Rider |
$5.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: Vantage Medical Group Senior |
$6.70
|
|
|
HC SOM MANGANESE
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC SOM MANGANESE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83785
|
| Hospital Charge Code |
900911066
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$248.66 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$178.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.66
|
| Rate for Payer: Blue Shield of California Commercial |
$12.60
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.97
|
| Rate for Payer: EPIC Health Plan Senior |
$29.32
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.71
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$28.25
|
| Rate for Payer: Riverside University Health System MISP |
$29.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.59
|
| Rate for Payer: United Healthcare All Other HMO |
$21.59
|
| Rate for Payer: United Healthcare HMO Rider |
$21.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Vantage Medical Group Senior |
$26.65
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC SOM MATERNAL CELL CONTAM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 81265
|
| Hospital Charge Code |
900915281
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$2,412.43 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$233.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,656.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$233.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,412.43
|
| Rate for Payer: Blue Shield of California Commercial |
$289.80
|
| Rate for Payer: Blue Shield of California EPN |
$182.62
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.57
|
| Rate for Payer: EPIC Health Plan Senior |
$256.38
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$382.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$328.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$233.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$363.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$312.31
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$233.07
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Medicare |
$247.05
|
| Rate for Payer: Riverside University Health System MISP |
$256.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.78
|
| Rate for Payer: United Healthcare All Other HMO |
$188.78
|
| Rate for Payer: United Healthcare HMO Rider |
$188.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$233.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.38
|
| Rate for Payer: Vantage Medical Group Senior |
$233.07
|
|
|
HC SOM MATRIX METALLOPROTEINASE 7
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| 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 |
$228.06
|
| Rate for Payer: Blue Shield of California EPN |
$143.71
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$231.68
|
| Rate for Payer: Cigna of CA PPO |
$267.88
|
| 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 |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.50
|
| Rate for Payer: EPIC Health Plan Senior |
$19.00
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| 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 |
$229.87
|
| 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 |
$72.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23.14
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| 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 |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| 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 MATRIX METALLOPROTEINASE 7
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
900915509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$213.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
|
OP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$1,715.87 |
| Rate for Payer: Adventist Health Commercial |
$10.27
|
| Rate for Payer: Adventist Health Medi-Cal |
$21.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$157.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,234.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,715.87
|
| Rate for Payer: Blue Shield of California Commercial |
$32.34
|
| Rate for Payer: Blue Shield of California EPN |
$20.38
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Central Health Plan Commercial |
$41.07
|
| Rate for Payer: Cigna of CA HMO |
$32.86
|
| Rate for Payer: Cigna of CA PPO |
$37.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.34
|
| Rate for Payer: EPIC Health Plan Senior |
$23.56
|
| Rate for Payer: Galaxy Health WC |
$43.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.21
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$38.51
|
| Rate for Payer: Networks By Design Commercial |
$33.37
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$21.42
|
| Rate for Payer: Prime Health Services Commercial |
$43.64
|
| Rate for Payer: Prime Health Services Medicare |
$22.71
|
| Rate for Payer: Riverside University Health System MISP |
$23.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$21.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC SOM MBCR 88271 SOM
|
Facility
|
IP
|
$51.34
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900914721
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$46.21 |
| Rate for Payer: Adventist Health Commercial |
$10.27
|
| Rate for Payer: Cash Price |
$51.34
|
| Rate for Payer: Central Health Plan Commercial |
$41.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.54
|
| Rate for Payer: EPIC Health Plan Senior |
$20.54
|
| Rate for Payer: Galaxy Health WC |
$43.64
|
| Rate for Payer: Global Benefits Group Commercial |
$30.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.27
|
| Rate for Payer: Multiplan Commercial |
$38.51
|
| Rate for Payer: Networks By Design Commercial |
$33.37
|
| Rate for Payer: Prime Health Services Commercial |
$43.64
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
|
IP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$56.22 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Central Health Plan Commercial |
$49.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.99
|
| Rate for Payer: EPIC Health Plan Senior |
$24.99
|
| Rate for Payer: Galaxy Health WC |
$53.10
|
| Rate for Payer: Global Benefits Group Commercial |
$37.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
| Rate for Payer: Networks By Design Commercial |
$40.61
|
| Rate for Payer: Prime Health Services Commercial |
$53.10
|
|
|
HC SOM MBCR 88275 SOM
|
Facility
|
OP
|
$62.47
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
900914722
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$2,647.34 |
| Rate for Payer: Adventist Health Commercial |
$12.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,904.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,647.34
|
| Rate for Payer: Blue Shield of California Commercial |
$39.36
|
| Rate for Payer: Blue Shield of California EPN |
$24.80
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Cash Price |
$62.47
|
| Rate for Payer: Central Health Plan Commercial |
$49.98
|
| Rate for Payer: Cigna of CA HMO |
$39.98
|
| Rate for Payer: Cigna of CA PPO |
$46.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.46
|
| Rate for Payer: EPIC Health Plan Senior |
$56.31
|
| Rate for Payer: Galaxy Health WC |
$53.10
|
| Rate for Payer: Global Benefits Group Commercial |
$37.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.22
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$83.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.59
|
| Rate for Payer: Multiplan Commercial |
$46.85
|
| Rate for Payer: Networks By Design Commercial |
$40.61
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.19
|
| Rate for Payer: Prime Health Services Commercial |
$53.10
|
| Rate for Payer: Prime Health Services Medicare |
$54.26
|
| Rate for Payer: Riverside University Health System MISP |
$56.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.46
|
| Rate for Payer: United Healthcare All Other HMO |
$41.46
|
| Rate for Payer: United Healthcare HMO Rider |
$41.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.19
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
|
IP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$23.57 |
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Central Health Plan Commercial |
$20.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$19.64
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
|
|
HC SOM MBCR 88291 SOM
|
Facility
|
OP
|
$26.19
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
900914723
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$188.95 |
| Rate for Payer: Adventist Health Commercial |
$5.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.64
|
| 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 |
$16.50
|
| Rate for Payer: Blue Shield of California EPN |
$10.40
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Cash Price |
$26.19
|
| Rate for Payer: Central Health Plan Commercial |
$20.95
|
| Rate for Payer: Cigna of CA HMO |
$16.76
|
| Rate for Payer: Cigna of CA PPO |
$19.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.48
|
| Rate for Payer: EPIC Health Plan Senior |
$10.48
|
| Rate for Payer: Galaxy Health WC |
$22.26
|
| Rate for Payer: Global Benefits Group Commercial |
$15.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$19.64
|
| Rate for Payer: Networks By Design Commercial |
$17.02
|
| Rate for Payer: Prime Health Services Commercial |
$22.26
|
| Rate for Payer: Riverside University Health System MISP |
$10.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.71
|
| 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 |
$22.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.26
|
| Rate for Payer: Vantage Medical Group Senior |
$22.26
|
|
|
HC SOM MCLON IFE U
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$215.42 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$215.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.74
|
| Rate for Payer: Blue Shield of California Commercial |
$18.18
|
| Rate for Payer: Blue Shield of California EPN |
$11.46
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Central Health Plan Commercial |
$23.09
|
| Rate for Payer: Cigna of CA HMO |
$18.47
|
| Rate for Payer: Cigna of CA PPO |
$21.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.43
|
| Rate for Payer: EPIC Health Plan Senior |
$32.28
|
| Rate for Payer: Galaxy Health WC |
$24.53
|
| Rate for Payer: Global Benefits Group Commercial |
$17.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.97
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.33
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
| Rate for Payer: Networks By Design Commercial |
$18.76
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.35
|
| Rate for Payer: Prime Health Services Commercial |
$24.53
|
| Rate for Payer: Prime Health Services Medicare |
$31.11
|
| Rate for Payer: Riverside University Health System MISP |
$32.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.78
|
| Rate for Payer: United Healthcare All Other HMO |
$23.78
|
| Rate for Payer: United Healthcare HMO Rider |
$23.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.28
|
| Rate for Payer: Vantage Medical Group Senior |
$29.35
|
|
|
HC SOM MCLON IFE U
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
900912768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Adventist Health Commercial |
$5.77
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Central Health Plan Commercial |
$23.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.54
|
| Rate for Payer: EPIC Health Plan Senior |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$24.53
|
| Rate for Payer: Global Benefits Group Commercial |
$17.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$21.64
|
| Rate for Payer: Networks By Design Commercial |
$18.76
|
| Rate for Payer: Prime Health Services Commercial |
$24.53
|
|
