|
HC ABL IE GT 1 TMR PR ORG INC FL US
|
Facility
|
OP
|
$27,474.00
|
|
|
Service Code
|
CPT 0601T
|
| Hospital Charge Code |
909000601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,861.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$16,484.40
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$12,363.30
|
| Rate for Payer: Cash Price |
$12,363.30
|
| Rate for Payer: Cigna of CA PPO |
$20,330.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Dignity Health Media |
$12,861.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,147.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,362.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12,861.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,861.31
|
| Rate for Payer: Galaxy Health WC |
$23,352.90
|
| Rate for Payer: Global Benefits Group Commercial |
$16,484.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20,605.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21,092.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$21,092.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,835.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20,835.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12,861.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,325.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,467.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,861.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,593.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,205.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,234.16
|
| Rate for Payer: Multiplan Commercial |
$21,979.20
|
| Rate for Payer: Multiplan WC |
$17,583.26
|
| Rate for Payer: Networks By Design Commercial |
$17,858.10
|
| Rate for Payer: Prime Health Services Commercial |
$23,352.90
|
| Rate for Payer: Prime Health Services WC |
$17,403.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,484.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,291.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,147.44
|
| Rate for Payer: Vantage Medical Group Senior |
$12,861.31
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.04
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC ABO UNIT CONFIRMATION
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
900904524
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.46
|
| Rate for Payer: Blue Distinction Transplant |
$162.60
|
| Rate for Payer: Blue Shield of California Commercial |
$199.73
|
| Rate for Payer: Blue Shield of California EPN |
$158.26
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Cigna of CA HMO |
$173.44
|
| Rate for Payer: Cigna of CA PPO |
$200.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$203.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$110.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.20
|
| Rate for Payer: Blue Distinction Transplant |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$30.21
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Media |
$18.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$44.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.57
|
| Rate for Payer: Heritage Provider Network Transplant |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$30.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$74.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$67.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.14
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$15.87
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Media |
$8.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.42 |
| Max. Negotiated Rate |
$1,761.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$762.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.42
|
| Rate for Payer: Blue Distinction Transplant |
$318.60
|
| Rate for Payer: Blue Shield of California Commercial |
$343.03
|
| Rate for Payer: Blue Shield of California EPN |
$271.87
|
| Rate for Payer: Cash Price |
$238.95
|
| Rate for Payer: Cash Price |
$238.95
|
| Rate for Payer: Cigna of CA HMO |
$339.84
|
| Rate for Payer: Cigna of CA PPO |
$392.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$451.35
|
| Rate for Payer: Global Benefits Group Commercial |
$318.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$398.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: Networks By Design Commercial |
$345.15
|
| Rate for Payer: Prime Health Services Commercial |
$451.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$318.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$318.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.20
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$60.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.93
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California EPN |
$13.31
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Media |
$6.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$10.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$107.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.75
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.09
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC A.C. JOINTS
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.21 |
| Max. Negotiated Rate |
$889.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$174.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.94
|
| Rate for Payer: Blue Distinction Transplant |
$627.60
|
| Rate for Payer: Blue Shield of California Commercial |
$618.19
|
| Rate for Payer: Blue Shield of California EPN |
$490.57
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cigna of CA HMO |
$669.44
|
| Rate for Payer: Cigna of CA PPO |
$774.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$784.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$836.80
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC A.C. JOINTS
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$889.10 |
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.40
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.04
|
| Rate for Payer: Multiplan Commercial |
$836.80
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
IP
|
$130,670.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$31,360.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$58,801.50
|
| Rate for Payer: Cash Price |
$58,801.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,268.00
|
| Rate for Payer: Galaxy Health WC |
$111,069.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78,402.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87,156.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49,785.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,360.80
|
| Rate for Payer: Multiplan Commercial |
$104,536.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$111,069.50
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
OP
|
$130,670.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$31,360.80 |
| Max. Negotiated Rate |
$111,069.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$85,706.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111,069.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71,868.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71,868.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77,853.19
|
| Rate for Payer: Blue Distinction Transplant |
$78,402.00
|
| Rate for Payer: Blue Shield of California Commercial |
$96,303.79
|
| Rate for Payer: Blue Shield of California EPN |
$76,311.28
|
| Rate for Payer: Cash Price |
$58,801.50
|
| Rate for Payer: Cigna of CA HMO |
$83,628.80
|
| Rate for Payer: Cigna of CA PPO |
$96,695.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111,069.50
|
| Rate for Payer: Dignity Health Media |
$111,069.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$111,069.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52,268.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$52,268.00
|
| Rate for Payer: Galaxy Health WC |
$111,069.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78,402.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$98,002.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87,156.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49,785.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31,360.80
|
| Rate for Payer: Multiplan Commercial |
$104,536.00
|
| Rate for Payer: Networks By Design Commercial |
$84,935.50
|
| Rate for Payer: Prime Health Services Commercial |
$111,069.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78,402.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78,402.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65,335.00
|
| Rate for Payer: United Healthcare All Other HMO |
$65,335.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65,335.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65,335.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111,069.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111,069.50
|
| Rate for Payer: Vantage Medical Group Senior |
$111,069.50
|
|
|
HC ACTH
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.28 |
| Max. Negotiated Rate |
$352.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$321.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.39
|
| Rate for Payer: Blue Distinction Transplant |
$88.80
|
| Rate for Payer: Blue Shield of California Commercial |
$95.61
|
| Rate for Payer: Blue Shield of California EPN |
$75.78
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Media |
$38.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.62
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.34
|
| Rate for Payer: Heritage Provider Network Transplant |
$63.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$62.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.28
|
| Rate for Payer: United Healthcare HMO Rider |
$31.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$795.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.86
|
| Rate for Payer: Blue Distinction Transplant |
$105.60
|
| Rate for Payer: Blue Shield of California Commercial |
$104.02
|
| Rate for Payer: Blue Shield of California EPN |
$82.54
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$132.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$557.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.55
|
| Rate for Payer: Blue Distinction Transplant |
$393.60
|
| Rate for Payer: Blue Shield of California Commercial |
$387.70
|
| Rate for Payer: Blue Shield of California EPN |
$307.66
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna of CA HMO |
$419.84
|
| Rate for Payer: Cigna of CA PPO |
$485.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$492.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ACUTE ABD SERIES
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
909001701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$557.60 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.40
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.44
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
|
|
HC ACUTE HEPATITIS PANEL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
900910701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.97
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$47.16
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.44
|
| Rate for Payer: Dignity Health Media |
$47.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.63
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$78.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$78.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$77.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.82
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.58
|
| Rate for Payer: United Healthcare All Other HMO |
$38.58
|
| Rate for Payer: United Healthcare HMO Rider |
$38.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.39
|
| Rate for Payer: Vantage Medical Group Senior |
$47.63
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$460.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$460.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$116.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$127.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$135.68
|
| Rate for Payer: Cigna of CA PPO |
$156.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Media |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC ADAPTION/TRAIN SPEECH DEVICE MCAL
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 92606
|
| Hospital Charge Code |
907000001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$330.65 |
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$259.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.36
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.90 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.10
|
| Rate for Payer: Blue Distinction Transplant |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$59.43
|
| Rate for Payer: Blue Shield of California EPN |
$47.10
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.20
|
| Rate for Payer: Dignity Health Media |
$78.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$78.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.80
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78.20
|
| Rate for Payer: Vantage Medical Group Senior |
$78.20
|
|
|
HC ADDL DIAG CD19
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$336.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.66
|
| Rate for Payer: Blue Distinction Transplant |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$93.02
|
| Rate for Payer: Blue Shield of California EPN |
$73.73
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: Dignity Health Media |
$37.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$61.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC ADDL DIAG CD19
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
