|
HC CATH WINGMAN CROSSING
|
Facility
|
OP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$26,837.02 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,837.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,134.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,910.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,490.44
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Cigna of CA HMO |
$2,483.84
|
| Rate for Payer: Cigna of CA PPO |
$2,871.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,298.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,298.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,464.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,408.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,289.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,716.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,716.70
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,328.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,328.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,940.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,940.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,940.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,940.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,298.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,298.85
|
|
|
HC CATH WINGMAN CROSSING
|
Facility
|
IP
|
$3,881.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
909000020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.20 |
| Max. Negotiated Rate |
$3,298.85 |
| Rate for Payer: Adventist Health Commercial |
$776.20
|
| Rate for Payer: Cash Price |
$1,746.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,716.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,552.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,552.40
|
| Rate for Payer: Galaxy Health WC |
$3,298.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,328.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,464.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,289.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.44
|
| Rate for Payer: Multiplan Commercial |
$3,104.80
|
| Rate for Payer: Networks By Design Commercial |
$2,522.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,298.85
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$261.12
|
| Rate for Payer: Cigna of CA PPO |
$301.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC CAVERNOSGRAPHY INJECTION
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 54230
|
| Hospital Charge Code |
909080039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
|
|
HC CAVILON BARRIER WAND 1ML
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC CAVILON BARRIER WAND 1ML
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698609
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$60.16
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Cigna of CA PPO |
$69.56
|
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$23.97
|
| Rate for Payer: Blue Shield of California Commercial |
$65.52
|
| Rate for Payer: Blue Shield of California Commercial |
$36.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W DIFFERENTIAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC CBC WITHOUT DIFFERENTIAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$23.97
|
| Rate for Payer: Blue Shield of California Commercial |
$47.94
|
| Rate for Payer: Blue Shield of California Commercial |
$36.24
|
| Rate for Payer: Blue Shield of California Commercial |
$72.49
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$17.06
|
| Rate for Payer: Blue Shield of California Commercial |
$47.94
|
| Rate for Payer: Blue Shield of California Commercial |
$25.79
|
| Rate for Payer: Blue Shield of California Commercial |
$72.49
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
|
|
HC CBC WO DIFFERENTIAL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900910086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC CBC W WBC AUTO DIFF
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900910092
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: EPIC Health Plan Commercial |
$12.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$8.55
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.26
|
| Rate for Payer: Blue Shield of California Commercial |
$23.97
|
| Rate for Payer: Blue Shield of California Commercial |
$104.55
|
| Rate for Payer: Blue Shield of California Commercial |
$36.24
|
| Rate for Payer: Blue Shield of California Commercial |
$69.15
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.82
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
|
|
HC CBC W WBC AUTO DIFFERENTIAL INDIV
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
900912018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$123.25 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.26
|
| Rate for Payer: Blue Shield of California Commercial |
$23.97
|
| Rate for Payer: Blue Shield of California Commercial |
$101.06
|
| Rate for Payer: Blue Shield of California Commercial |
$36.24
|
| Rate for Payer: Blue Shield of California Commercial |
$66.84
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| Rate for Payer: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$8.55
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.74
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare All Other HMO |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare HMO Rider |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
| Rate for Payer: Vantage Medical Group Senior |
$7.77
|
|
|
HC CBC W WO DIFFERENTIAL INDIVIDUAL
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$66.78 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$43.33
|
| Rate for Payer: Blue Shield of California Commercial |
$23.97
|
| Rate for Payer: Blue Shield of California Commercial |
$65.52
|
| Rate for Payer: Blue Shield of California Commercial |
$36.24
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$60.16
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Cigna of CA PPO |
$69.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CBC W WO DIFFERENTIAL INDIVIDUAL
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
900912019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.56
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
|
|
HC CD3
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$389.30 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.92
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: Networks By Design Commercial |
$297.70
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
|
|
HC CD3
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$390.04 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.04
|
| Rate for Payer: Blue Shield of California Commercial |
$211.14
|
| Rate for Payer: Blue Shield of California Commercial |
$133.13
|
| Rate for Payer: Blue Shield of California Commercial |
$319.23
|
| Rate for Payer: Blue Shield of California Commercial |
$88.05
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$293.12
|
| Rate for Payer: Cigna of CA HMO |
$122.24
|
| Rate for Payer: Cigna of CA PPO |
$141.34
|
| Rate for Payer: Cigna of CA PPO |
$338.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$297.70
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC CD45 LEUKEMIA/LYMPHOMA
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903900100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC CD45 LEUKEMIA/LYMPHOMA
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
903900100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$760.68 |
| Rate for Payer: Adventist Health Commercial |
$83.40
|
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.62
|
| Rate for Payer: Blue Shield of California Commercial |
$356.35
|
| Rate for Payer: Blue Shield of California Commercial |
$192.24
|
| Rate for Payer: Blue Shield of California Commercial |
$538.78
|
| Rate for Payer: Blue Shield of California Commercial |
$290.65
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cash Price |
$187.65
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA HMO |
$266.88
|
| Rate for Payer: Cigna of CA PPO |
$308.58
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$291.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$354.45
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$250.20
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Networks By Design Commercial |
$271.05
|
| Rate for Payer: Prime Health Services Commercial |
$354.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Upland Medical Group Pediatric |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
HC C DIFFICILE TOXIN A/B ASSAY
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900911750
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC C DIFFICILE TOXIN A/B ASSAY
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900911750
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$132.77
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Blue Shield of California Commercial |
$200.74
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CDIFF NUCLEIC ACID TEST
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
900912489
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
