|
HC HLA X MATCH B FLOW
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 86356
|
| Hospital Charge Code |
903901936
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$244.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$222.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.28
|
| Rate for Payer: Blue Distinction Transplant |
$161.40
|
| Rate for Payer: Blue Shield of California Commercial |
$173.77
|
| Rate for Payer: Blue Shield of California EPN |
$137.73
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Media |
$26.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.78
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$201.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$43.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$43.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$359.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$359.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.37
|
| Rate for Payer: Blue Distinction Transplant |
$119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$128.55
|
| Rate for Payer: Blue Shield of California EPN |
$101.89
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cigna of CA HMO |
$127.36
|
| Rate for Payer: Cigna of CA PPO |
$147.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Media |
$189.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$189.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.51
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$149.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.80
|
| Rate for Payer: Heritage Provider Network Transplant |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$307.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$238.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA X MATCH B SEROLOGY
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC HLA X MATCH T FLOW
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$667.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$667.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$109.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.22
|
| Rate for Payer: Blue Distinction Transplant |
$164.40
|
| Rate for Payer: Blue Shield of California Commercial |
$177.00
|
| Rate for Payer: Blue Shield of California EPN |
$140.29
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.24
|
| Rate for Payer: Dignity Health Media |
$109.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$147.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$109.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.49
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$205.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$179.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$179.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$177.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$109.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$146.72
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.69
|
| Rate for Payer: United Healthcare All Other HMO |
$88.69
|
| Rate for Payer: United Healthcare HMO Rider |
$88.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.44
|
| Rate for Payer: Vantage Medical Group Senior |
$109.49
|
|
|
HC HLA X MATCH T FLOW
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT 86825
|
| Hospital Charge Code |
903901914
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$563.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$676.00
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$359.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$359.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$328.37
|
| Rate for Payer: Blue Distinction Transplant |
$119.40
|
| Rate for Payer: Blue Shield of California Commercial |
$128.55
|
| Rate for Payer: Blue Shield of California EPN |
$101.89
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cash Price |
$89.55
|
| Rate for Payer: Cigna of CA HMO |
$127.36
|
| Rate for Payer: Cigna of CA PPO |
$147.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$284.26
|
| Rate for Payer: Dignity Health Media |
$189.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$208.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$189.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.51
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$149.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$310.80
|
| Rate for Payer: Heritage Provider Network Transplant |
$310.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$307.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$189.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$238.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.94
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$129.35
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.50
|
| Rate for Payer: United Healthcare All Other HMO |
$153.50
|
| Rate for Payer: United Healthcare HMO Rider |
$153.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$153.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$284.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.46
|
| Rate for Payer: Vantage Medical Group Senior |
$189.51
|
|
|
HC HLA X MATCH T SEROLOGY
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 86805
|
| Hospital Charge Code |
903901924
|
|
Hospital Revenue Code
|
302
|
| 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 HLA XM T FLOW, ADDL SERUM
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$58.56 |
| Max. Negotiated Rate |
$207.40 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC HLA XM T FLOW, ADDL SERUM
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86826
|
| Hospital Charge Code |
903902015
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$222.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$222.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.78
|
| Rate for Payer: Blue Distinction Transplant |
$146.40
|
| Rate for Payer: Blue Shield of California Commercial |
$157.62
|
| Rate for Payer: Blue Shield of California EPN |
$124.93
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Cigna of CA HMO |
$156.16
|
| Rate for Payer: Cigna of CA PPO |
$180.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.80
|
| Rate for Payer: Dignity Health Media |
$36.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$36.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.53
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$183.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$59.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$59.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$36.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.95
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.59
|
| Rate for Payer: United Healthcare All Other HMO |
$29.59
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.18
|
| Rate for Payer: Vantage Medical Group Senior |
$36.53
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$111.37 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$595.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.70
|
| Rate for Payer: Blue Distinction Transplant |
$414.60
|
| Rate for Payer: Blue Shield of California Commercial |
$509.27
|
| Rate for Payer: Blue Shield of California EPN |
$403.54
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Cigna of CA HMO |
$442.24
|
| Rate for Payer: Cigna of CA PPO |
$511.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$587.35
|
| Rate for Payer: Global Benefits Group Commercial |
$414.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$518.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.65
|
| Rate for Payer: Heritage Provider Network Transplant |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$180.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$180.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Networks By Design Commercial |
$449.15
|
| Rate for Payer: Prime Health Services Commercial |
$587.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$414.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$414.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$587.35 |
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.40
|
| Rate for Payer: Galaxy Health WC |
$587.35
|
| Rate for Payer: Global Benefits Group Commercial |
$414.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$460.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Networks By Design Commercial |
$449.15
|
| Rate for Payer: Prime Health Services Commercial |
$587.35
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$433.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$433.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.07
|
| Rate for Payer: Blue Distinction Transplant |
$47.40
|
| Rate for Payer: Blue Shield of California Commercial |
$58.22
|
| Rate for Payer: Blue Shield of California EPN |
$46.14
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$58.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$58.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$154.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.83
|
| Rate for Payer: Blue Distinction Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.48
|
| Rate for Payer: Blue Shield of California EPN |
$23.36
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Media |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$160.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$160.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.81
|
| Rate for Payer: Blue Distinction Transplant |
$44.40
|
| Rate for Payer: Blue Shield of California Commercial |
$47.80
|
| Rate for Payer: Blue Shield of California EPN |
$37.89
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Media |
$22.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.25
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$55.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$36.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$36.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.03
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.15
|
| Rate for Payer: United Healthcare All Other HMO |
$18.15
|
| Rate for Payer: United Healthcare HMO Rider |
$18.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$56.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.24
|
| Rate for Payer: Blue Distinction Transplant |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$63.38
|
| Rate for Payer: Blue Shield of California EPN |
$50.22
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| 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 |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$73.10 |
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC HPV BY NUCLEIC ACID
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
900913641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$282.26 |
| Rate for Payer: Aetna of CA HMO/PPO |
$282.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.17
|
| Rate for Payer: Blue Distinction Transplant |
$33.60
|
| Rate for Payer: Blue Shield of California Commercial |
$36.18
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$56.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC H. PYLORI AB, IGG
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
900913556
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.87
|
| Rate for Payer: Blue Distinction Transplant |
$33.60
|
| Rate for Payer: Blue Shield of California Commercial |
$36.18
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.28
|
| Rate for Payer: Dignity Health Media |
$16.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.85
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$27.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.58
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.65
|
| Rate for Payer: United Healthcare All Other HMO |
$13.65
|
| Rate for Payer: United Healthcare HMO Rider |
$13.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.54
|
| Rate for Payer: Vantage Medical Group Senior |
$16.85
|
|
|
HC H REFLEX SOLEUS
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
900600259
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
|
|
HC H REFLEX SOLEUS
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
900600259
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.44
|
| Rate for Payer: Blue Distinction Transplant |
$109.20
|
| Rate for Payer: Blue Shield of California Commercial |
$107.56
|
| Rate for Payer: Blue Shield of California EPN |
$85.36
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Media |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$136.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
|
IP
|
$8,746.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,099.04 |
| Max. Negotiated Rate |
$7,434.10 |
| Rate for Payer: Cash Price |
$3,935.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,498.40
|
| Rate for Payer: Galaxy Health WC |
$7,434.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,833.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,332.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.04
|
| Rate for Payer: Multiplan Commercial |
$6,996.80
|
| Rate for Payer: Networks By Design Commercial |
$5,684.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,434.10
|
|
|
HC HRHC INT TRANAL DARTLZN 2+
|
Facility
|
OP
|
$8,746.00
|
|
|
Service Code
|
CPT 46948
|
| Hospital Charge Code |
906706948
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.70 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,508.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,247.60
|
| 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 |
$3,935.70
|
| Rate for Payer: Cash Price |
$3,935.70
|
| Rate for Payer: Cigna of CA PPO |
$6,472.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Dignity Health Media |
$3,508.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,858.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,736.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,508.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,508.15
|
| Rate for Payer: Galaxy Health WC |
$7,434.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,247.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,559.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,753.37
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,753.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,683.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5,683.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,508.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,833.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,508.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,099.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,420.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,700.92
|
| Rate for Payer: Multiplan Commercial |
$6,996.80
|
| Rate for Payer: Networks By Design Commercial |
$5,684.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,434.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,247.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,262.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,858.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,508.15
|
|
|
HC HSV 1,2 IGM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
900913562
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$130.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.89
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
