|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$218.88 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.80
|
| Rate for Payer: Galaxy Health WC |
$775.20
|
| Rate for Payer: Global Benefits Group Commercial |
$547.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.88
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: Networks By Design Commercial |
$592.80
|
| Rate for Payer: Prime Health Services Commercial |
$775.20
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$194.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$775.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$501.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$501.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.37
|
| Rate for Payer: Blue Distinction Transplant |
$547.20
|
| Rate for Payer: Blue Shield of California Commercial |
$538.99
|
| Rate for Payer: Blue Shield of California EPN |
$427.73
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cigna of CA HMO |
$583.68
|
| Rate for Payer: Cigna of CA PPO |
$674.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$775.20
|
| Rate for Payer: Dignity Health Media |
$775.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$775.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$364.80
|
| Rate for Payer: Galaxy Health WC |
$775.20
|
| Rate for Payer: Global Benefits Group Commercial |
$547.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$608.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.88
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: Networks By Design Commercial |
$592.80
|
| Rate for Payer: Prime Health Services Commercial |
$775.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$547.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$547.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$456.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$775.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$775.20
|
| Rate for Payer: Vantage Medical Group Senior |
$775.20
|
|
|
HC AUDIOLOGIC EVAL PURE TONE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601816
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$194.83
|
| Rate for Payer: Blue Distinction Transplant |
$196.20
|
| Rate for Payer: Blue Shield of California Commercial |
$193.26
|
| Rate for Payer: Blue Shield of California EPN |
$153.36
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA HMO |
$209.28
|
| Rate for Payer: Cigna of CA PPO |
$241.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Media |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$245.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC AUDIOLOGIC EVAL PURE TONE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601816
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
|
|
HC AUG/ALTR COMM
|
Facility
|
IP
|
$222.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$188.70 |
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
|
HC AUG/ALTR COMM
|
Facility
|
OP
|
$222.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$145.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$133.20
|
| 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 |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna of CA HMO |
$142.08
|
| Rate for Payer: Cigna of CA PPO |
$164.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Media |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$166.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.28
|
| Rate for Payer: Multiplan Commercial |
$177.60
|
| Rate for Payer: Networks By Design Commercial |
$144.30
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| 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 |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.84 |
| Max. Negotiated Rate |
$672.35 |
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.40
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$474.60
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cash Price |
$355.95
|
| Rate for Payer: Cigna of CA PPO |
$585.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$593.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.50
|
| Rate for Payer: United Healthcare All Other HMO |
$395.50
|
| Rate for Payer: United Healthcare HMO Rider |
$395.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$395.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$253.80
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cigna of CA PPO |
$313.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.55
|
| Rate for Payer: Dignity Health Media |
$359.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$317.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.52
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.50
|
| Rate for Payer: United Healthcare All Other HMO |
$211.50
|
| Rate for Payer: United Healthcare HMO Rider |
$211.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$359.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.55
|
| Rate for Payer: Vantage Medical Group Senior |
$359.55
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.52 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.52
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC B ABORTUS AB
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$57.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.49
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Media |
$6.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$90.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.29
|
| Rate for Payer: Blue Distinction Transplant |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$54.26
|
| Rate for Payer: Blue Shield of California EPN |
$43.01
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.31
|
| Rate for Payer: Dignity Health Media |
$11.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.46
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.35
|
| Rate for Payer: United Healthcare All Other HMO |
$9.35
|
| Rate for Payer: United Healthcare HMO Rider |
$9.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Vantage Medical Group Senior |
$11.54
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
IP
|
$3,686.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$884.64 |
| Max. Negotiated Rate |
$3,133.10 |
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,474.40
|
| Rate for Payer: Galaxy Health WC |
$3,133.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,211.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,458.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,404.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.64
|
| Rate for Payer: Multiplan Commercial |
$2,948.80
|
| Rate for Payer: Networks By Design Commercial |
$2,395.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.10
|
|
|
HC BALLOON OCCLUSION ADDL LOBES
|
Facility
|
OP
|
$3,686.00
|
|
|
Service Code
|
CPT 31651
|
| Hospital Charge Code |
900531651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,133.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,027.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,027.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,211.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Cash Price |
$1,658.70
|
| Rate for Payer: Cigna of CA PPO |
$2,727.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,133.10
|
| Rate for Payer: Dignity Health Media |
$3,133.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,133.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,474.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.40
|
| Rate for Payer: Galaxy Health WC |
$3,133.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,211.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,764.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,458.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$884.64
|
| Rate for Payer: Multiplan Commercial |
$2,948.80
|
| Rate for Payer: Networks By Design Commercial |
$2,395.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,133.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,211.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,133.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,133.10
|
| Rate for Payer: Vantage Medical Group Senior |
$3,133.10
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.24
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$903.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.66
|
| Rate for Payer: Blue Distinction Transplant |
$1,392.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,371.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,088.08
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.80
|
| Rate for Payer: Cigna of CA PPO |
$1,716.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,972.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,392.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,740.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,547.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: Networks By Design Commercial |
$1,508.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,972.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,392.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,392.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$556.80 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.00
|
| Rate for Payer: Galaxy Health WC |
$1,972.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,392.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,547.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$883.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$556.80
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: Networks By Design Commercial |
$1,508.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,972.00
|
|
|
HC BASIC DOSIMETRY
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$106.63 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$245.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.08
|
| Rate for Payer: Blue Distinction Transplant |
$852.00
|
| Rate for Payer: Blue Shield of California Commercial |
$839.22
|
| Rate for Payer: Blue Shield of California EPN |
$665.98
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna of CA HMO |
$908.80
|
| Rate for Payer: Cigna of CA PPO |
$1,050.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,065.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,136.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$852.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC BASIC DOSIMETRY
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$340.80 |
| Max. Negotiated Rate |
$1,207.00 |
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.00
|
| Rate for Payer: Galaxy Health WC |
$1,207.00
|
| Rate for Payer: Global Benefits Group Commercial |
$852.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$947.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$541.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.80
|
| Rate for Payer: Multiplan Commercial |
$1,136.00
|
| Rate for Payer: Networks By Design Commercial |
$923.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,207.00
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$77.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.21
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| 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 |
$12.69
|
| Rate for Payer: Dignity Health Media |
$8.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.87
|
| Rate for Payer: Heritage Provider Network Transplant |
$13.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| 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 |
$6.85
|
| Rate for Payer: United Healthcare All Other HMO |
$6.85
|
| Rate for Payer: United Healthcare HMO Rider |
$6.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC BCEDP CASE MANAGEMENT FEE
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
909099998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.24
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$23.05
|
| Rate for Payer: Blue Shield of California EPN |
$18.29
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Media |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC BC-GN NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912467
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$182.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.80
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Media |
$20.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BC-GP NUCLEIC ACID ID CULTURE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912451
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$182.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.80
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.08
|
| Rate for Payer: Dignity Health Media |
$20.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.05
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$32.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$32.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.24
|
| Rate for Payer: United Healthcare All Other HMO |
$16.24
|
| Rate for Payer: United Healthcare HMO Rider |
$16.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.06
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC BCT LIMITED STUDY
|
Facility
|
OP
|
$1,045.00
|
|
|
Service Code
|
CPT 76380
|
| Hospital Charge Code |
909201971
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| 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 |
$622.61
|
| Rate for Payer: Blue Distinction Transplant |
$627.00
|
| Rate for Payer: Blue Shield of California Commercial |
$617.60
|
| Rate for Payer: Blue Shield of California EPN |
$490.10
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cigna of CA HMO |
$668.80
|
| Rate for Payer: Cigna of CA PPO |
$773.30
|
| 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 |
$888.25
|
| Rate for Payer: Global Benefits Group Commercial |
$627.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$783.75
|
| 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 |
$697.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.80
|
| 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 |
$836.00
|
| Rate for Payer: Networks By Design Commercial |
$679.25
|
| Rate for Payer: Prime Health Services Commercial |
$888.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$522.50
|
| Rate for Payer: United Healthcare All Other HMO |
$522.50
|
| Rate for Payer: United Healthcare HMO Rider |
$522.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$522.50
|
| 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
|
|
