|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$141.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$141.76
|
| 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 |
$25.86
|
| Rate for Payer: Blue Distinction Transplant |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$40.70
|
| Rate for Payer: Blue Shield of California EPN |
$32.26
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: Cigna of CA HMO |
$40.32
|
| Rate for Payer: Cigna of CA PPO |
$46.62
|
| 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 |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.25
|
| 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 |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| 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 |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| 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 LEVEL II-GROSS & MICRO EXAM
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$297.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$297.62
|
| 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 |
$63.76
|
| Rate for Payer: Blue Distinction Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$41.34
|
| Rate for Payer: Blue Shield of California EPN |
$32.77
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| 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 |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.00
|
| 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 |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| 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 |
$51.20
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| 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 LEVEL II-GROSS & MICRO EXAM
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$327.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$327.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.68
|
| Rate for Payer: Blue Distinction Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$58.14
|
| Rate for Payer: Blue Shield of California EPN |
$46.08
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$343.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
|
|
HC LEVEL III PG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800203
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC LEVEL III PG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800203
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$327.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$327.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.68
|
| Rate for Payer: Blue Distinction Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$71.06
|
| Rate for Payer: Blue Shield of California EPN |
$56.32
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LEVEL II PG
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$297.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$297.62
|
| 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 |
$63.76
|
| Rate for Payer: Blue Distinction Transplant |
$64.80
|
| Rate for Payer: Blue Shield of California Commercial |
$69.77
|
| Rate for Payer: Blue Shield of California EPN |
$55.30
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna of CA HMO |
$69.12
|
| Rate for Payer: Cigna of CA PPO |
$79.92
|
| 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 |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$81.00
|
| 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 |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| 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 |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| 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 LEVEL II PG
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.20
|
| Rate for Payer: Galaxy Health WC |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.92
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Networks By Design Commercial |
$70.20
|
| Rate for Payer: Prime Health Services Commercial |
$91.80
|
|
|
HC LEVEL I PG
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$124.10 |
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.40
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
|
|
HC LEVEL I PG
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$141.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$141.76
|
| 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 |
$25.86
|
| Rate for Payer: Blue Distinction Transplant |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$94.32
|
| Rate for Payer: Blue Shield of California EPN |
$74.75
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| 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 |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$109.50
|
| 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 |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| 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 |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| 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 LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$194.88 |
| Max. Negotiated Rate |
$690.20 |
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.80
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
|
|
HC LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$442.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.09
|
| Rate for Payer: Blue Distinction Transplant |
$71.40
|
| Rate for Payer: Blue Shield of California Commercial |
$76.87
|
| Rate for Payer: Blue Shield of California EPN |
$60.93
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cash Price |
$53.55
|
| Rate for Payer: Cigna of CA HMO |
$76.16
|
| Rate for Payer: Cigna of CA PPO |
$88.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$101.15
|
| Rate for Payer: Global Benefits Group Commercial |
$71.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$89.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$79.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Networks By Design Commercial |
$77.35
|
| Rate for Payer: Prime Health Services Commercial |
$101.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LEVEL IV PG
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800206
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$249.63 |
| Max. Negotiated Rate |
$1,761.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,295.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.63
|
| Rate for Payer: Blue Distinction Transplant |
$628.80
|
| Rate for Payer: Blue Shield of California Commercial |
$677.01
|
| Rate for Payer: Blue Shield of California EPN |
$536.58
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cigna of CA HMO |
$670.72
|
| Rate for Payer: Cigna of CA PPO |
$775.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$786.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC LEVEL IV PG
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC LEVEL IV PG
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800206
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$251.52 |
| Max. Negotiated Rate |
$890.80 |
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.52
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
|
|
HC LEVEL IV PG
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$442.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.09
|
| Rate for Payer: Blue Distinction Transplant |
$74.40
|
| Rate for Payer: Blue Shield of California Commercial |
$80.10
|
| Rate for Payer: Blue Shield of California EPN |
$63.49
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$93.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.16 |
| Max. Negotiated Rate |
$933.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$933.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.92
|
| Rate for Payer: Blue Distinction Transplant |
$245.40
|
| Rate for Payer: Blue Shield of California Commercial |
$264.21
|
| Rate for Payer: Blue Shield of California EPN |
$209.41
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cigna of CA HMO |
$261.76
|
| Rate for Payer: Cigna of CA PPO |
$302.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$306.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$736.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$727.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$727.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$245.40
|
| 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 HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$316.56 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$1,761.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,295.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.63
|
| Rate for Payer: Blue Distinction Transplant |
$198.00
|
| Rate for Payer: Blue Shield of California Commercial |
$213.18
|
| Rate for Payer: Blue Shield of California EPN |
$168.96
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$211.20
|
| Rate for Payer: Cigna of CA PPO |
$244.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$247.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,761.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,740.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,353.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$365.04 |
| Max. Negotiated Rate |
$1,292.85 |
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.40
|
| Rate for Payer: Galaxy Health WC |
$1,292.85
|
| Rate for Payer: Global Benefits Group Commercial |
$912.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,014.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$365.04
|
| Rate for Payer: Multiplan Commercial |
$1,216.80
|
| Rate for Payer: Networks By Design Commercial |
$988.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.85
|
|
|
HC LEVEL V PG
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$231.84 |
| Max. Negotiated Rate |
$821.10 |
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.40
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$644.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.84
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
|
|
HC LEVEL V PG
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.52 |
| Max. Negotiated Rate |
$933.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$933.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.92
|
| Rate for Payer: Blue Distinction Transplant |
$579.60
|
| Rate for Payer: Blue Shield of California Commercial |
$624.04
|
| Rate for Payer: Blue Shield of California EPN |
$494.59
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cigna of CA HMO |
$618.24
|
| Rate for Payer: Cigna of CA PPO |
$714.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$724.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$736.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$727.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$727.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$644.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$772.80
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$579.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$579.60
|
| 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 HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$17,062.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,094.88 |
| Max. Negotiated Rate |
$14,502.70 |
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,824.80
|
| Rate for Payer: Galaxy Health WC |
$14,502.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,237.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,380.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,500.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,094.88
|
| Rate for Payer: Multiplan Commercial |
$13,649.60
|
| Rate for Payer: Networks By Design Commercial |
$11,090.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,502.70
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$17,062.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,977.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,237.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Cigna of CA PPO |
$12,625.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$14,502.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,237.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,796.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,677.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,595.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,380.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,094.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,129.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$13,649.60
|
| Rate for Payer: Networks By Design Commercial |
$11,090.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,502.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,237.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
