|
HC CREATINE KINASE
|
Facility
|
OP
|
$55.09
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
900910222
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$64.77 |
| Rate for Payer: Adventist Health Commercial |
$11.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.77
|
| Rate for Payer: Blue Shield of California Commercial |
$36.86
|
| Rate for Payer: Blue Shield of California EPN |
$24.35
|
| Rate for Payer: Cash Price |
$24.79
|
| Rate for Payer: Cash Price |
$24.79
|
| Rate for Payer: Cigna of CA HMO |
$35.26
|
| Rate for Payer: Cigna of CA PPO |
$40.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.79
|
| Rate for Payer: EPIC Health Plan Senior |
$6.51
|
| Rate for Payer: Galaxy Health WC |
$46.83
|
| Rate for Payer: Global Benefits Group Commercial |
$33.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$44.07
|
| Rate for Payer: Networks By Design Commercial |
$35.81
|
| Rate for Payer: Prime Health Services Commercial |
$46.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.27
|
| Rate for Payer: United Healthcare All Other HMO |
$5.27
|
| Rate for Payer: United Healthcare HMO Rider |
$5.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.16
|
| Rate for Payer: Vantage Medical Group Senior |
$6.51
|
|
|
HC CREATININE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$50.54 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.54
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Other HMO |
$4.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
|
|
HC CREATININE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910247
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC CREATININE BODY FLUID
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900910377
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$33.45
|
| Rate for Payer: Blue Shield of California EPN |
$22.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$5.18
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC CREATININE BODY FLUID
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
900910377
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$107.95 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Cash Price |
$57.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.80
|
| Rate for Payer: EPIC Health Plan Senior |
$50.80
|
| Rate for Payer: Galaxy Health WC |
$107.95
|
| Rate for Payer: Global Benefits Group Commercial |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$101.60
|
| Rate for Payer: Networks By Design Commercial |
$82.55
|
| Rate for Payer: Prime Health Services Commercial |
$107.95
|
|
|
HC CREATININE CH
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900912181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.54
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.57
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Other HMO |
$4.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
|
|
HC CREATININE CH
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900912181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC CREATININE CLEARAN
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
900910260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$221.85 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$104.40
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$174.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$161.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.64
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
|
|
HC CREATININE CLEARAN
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
900910260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$93.16 |
| Rate for Payer: Adventist Health Commercial |
$18.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.16
|
| Rate for Payer: Blue Shield of California Commercial |
$61.55
|
| Rate for Payer: Blue Shield of California EPN |
$40.66
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna of CA HMO |
$58.88
|
| Rate for Payer: Cigna of CA PPO |
$68.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.77
|
| Rate for Payer: EPIC Health Plan Senior |
$9.46
|
| Rate for Payer: Galaxy Health WC |
$78.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$15.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.68
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Networks By Design Commercial |
$59.80
|
| Rate for Payer: Prime Health Services Commercial |
$78.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.66
|
| Rate for Payer: United Healthcare All Other HMO |
$7.66
|
| Rate for Payer: United Healthcare HMO Rider |
$7.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.66
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.41
|
| Rate for Payer: Vantage Medical Group Senior |
$9.46
|
|
|
HC CREATININE INDIVIDUAL
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$50.54 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.54
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.91
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Other HMO |
$4.15
|
| Rate for Payer: United Healthcare HMO Rider |
$4.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.63
|
| Rate for Payer: Vantage Medical Group Senior |
$5.12
|
|
|
HC CREATININE INDIVIDUAL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
900910493
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC CRITICAL CARE ADDL 30 MIN
|
Facility
|
OP
|
$6,354.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
900501641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.91 |
| Max. Negotiated Rate |
$5,400.90 |
| Rate for Payer: Adventist Health Commercial |
$1,270.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,400.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,494.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,765.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$2,859.30
|
| Rate for Payer: Cash Price |
$2,859.30
|
| Rate for Payer: Cash Price |
$2,859.30
|
| Rate for Payer: Cigna of CA HMO |
$4,066.56
|
| Rate for Payer: Cigna of CA PPO |
$4,701.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,400.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,400.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,400.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,541.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,541.60
|
| Rate for Payer: Galaxy Health WC |
$5,400.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,812.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,933.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,447.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,447.80
|
| Rate for Payer: Multiplan Commercial |
$5,083.20
|
| Rate for Payer: Networks By Design Commercial |
$4,130.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,400.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,812.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,177.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,177.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,177.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,177.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,400.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,400.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,400.90
|
|
|
HC CRITICAL CARE ADDL 30 MIN
|
Facility
|
IP
|
$6,354.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
900501641
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,270.80 |
| Max. Negotiated Rate |
$5,400.90 |
| Rate for Payer: Adventist Health Commercial |
$1,270.80
|
| Rate for Payer: Cash Price |
$2,859.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,541.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,541.60
|
| Rate for Payer: Galaxy Health WC |
$5,400.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,812.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,420.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,933.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,524.96
|
| Rate for Payer: Multiplan Commercial |
$5,083.20
|
| Rate for Payer: Networks By Design Commercial |
$4,130.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,400.90
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
OP
|
$12,719.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.04 |
| Max. Negotiated Rate |
$10,811.15 |
| Rate for Payer: Adventist Health Commercial |
$2,543.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,177.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,070.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$5,723.55
|
| Rate for Payer: Cash Price |
$5,723.55
|
| Rate for Payer: Cash Price |
$5,723.55
|
| Rate for Payer: Cigna of CA HMO |
$8,140.16
|
| Rate for Payer: Cigna of CA PPO |
$9,412.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,177.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,070.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,445.34
|
| Rate for Payer: EPIC Health Plan Senior |
$1,070.62
|
| Rate for Payer: Galaxy Health WC |
$10,811.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,631.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,755.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,070.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,483.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,070.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,052.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,348.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,434.63
|
| Rate for Payer: Multiplan Commercial |
$10,175.20
|
| Rate for Payer: Multiplan WC |
$1,705.85
|
| Rate for Payer: Networks By Design Commercial |
$8,267.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,811.15
|
| Rate for Payer: Prime Health Services WC |
$1,688.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,631.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,075.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,770.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,070.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,605.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,177.68
|
| Rate for Payer: Vantage Medical Group Senior |
$1,070.62
|
|
|
HC CRITICAL CARE E&M 30-74 MIN
|
Facility
|
IP
|
$12,719.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
900509291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,543.80 |
| Max. Negotiated Rate |
$10,811.15 |
| Rate for Payer: Adventist Health Commercial |
$2,543.80
|
| Rate for Payer: Cash Price |
$5,723.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,087.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,087.60
|
| Rate for Payer: Galaxy Health WC |
$10,811.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7,631.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,483.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,845.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,873.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,052.56
|
| Rate for Payer: Multiplan Commercial |
$10,175.20
|
| Rate for Payer: Networks By Design Commercial |
$8,267.35
|
| Rate for Payer: Prime Health Services Commercial |
$10,811.15
|
|
|
HC CROSSMATCH COMP
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.79
|
| Rate for Payer: Blue Shield of California Commercial |
$179.96
|
| Rate for Payer: Blue Shield of California EPN |
$118.90
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Cigna of CA HMO |
$172.16
|
| Rate for Payer: Cigna of CA PPO |
$199.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$161.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$161.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CROSSMATCH COMP
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
900904766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$228.65 |
| Rate for Payer: Adventist Health Commercial |
$53.80
|
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: EPIC Health Plan Senior |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.56
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC CROSSMATCH IS
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.38 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.49
|
| Rate for Payer: Blue Shield of California Commercial |
$458.93
|
| Rate for Payer: Blue Shield of California EPN |
$303.21
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: Cigna of CA HMO |
$439.04
|
| Rate for Payer: Cigna of CA PPO |
$507.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$411.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$411.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CROSSMATCH IS
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
900904577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$583.10 |
| Rate for Payer: Adventist Health Commercial |
$137.20
|
| Rate for Payer: Cash Price |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$274.40
|
| Rate for Payer: Galaxy Health WC |
$583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$411.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$457.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$424.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.64
|
| Rate for Payer: Multiplan Commercial |
$548.80
|
| Rate for Payer: Networks By Design Commercial |
$445.90
|
| Rate for Payer: Prime Health Services Commercial |
$583.10
|
|
|
HC CROSSMATCH XM
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.38 |
| Max. Negotiated Rate |
$646.85 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$499.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.49
|
| Rate for Payer: Blue Shield of California Commercial |
$509.11
|
| Rate for Payer: Blue Shield of California EPN |
$336.36
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: Cigna of CA HMO |
$487.04
|
| Rate for Payer: Cigna of CA PPO |
$563.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$608.80
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$456.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$456.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC CROSSMATCH XM
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
900904551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$646.85 |
| Rate for Payer: Adventist Health Commercial |
$152.20
|
| Rate for Payer: Cash Price |
$342.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.40
|
| Rate for Payer: EPIC Health Plan Senior |
$304.40
|
| Rate for Payer: Galaxy Health WC |
$646.85
|
| Rate for Payer: Global Benefits Group Commercial |
$456.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$507.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$471.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.64
|
| Rate for Payer: Multiplan Commercial |
$608.80
|
| Rate for Payer: Networks By Design Commercial |
$494.65
|
| Rate for Payer: Prime Health Services Commercial |
$646.85
|
|
|
HC CRPRA CVRNSA-CRPS SPNGSM SHNT, UNI OR BI
|
Facility
|
IP
|
$7,632.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
900504430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,526.40 |
| Max. Negotiated Rate |
$6,487.20 |
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.80
|
| Rate for Payer: Galaxy Health WC |
$6,487.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,907.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,724.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.68
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
|
|
HC CRPRA CVRNSA-CRPS SPNGSM SHNT, UNI OR BI
|
Facility
|
OP
|
$7,632.00
|
|
|
Service Code
|
CPT 54430
|
| Hospital Charge Code |
900504430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$929.48 |
| Max. Negotiated Rate |
$6,487.20 |
| Rate for Payer: Adventist Health Commercial |
$1,526.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,487.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,197.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,724.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cash Price |
$3,434.40
|
| Rate for Payer: Cigna of CA HMO |
$4,884.48
|
| Rate for Payer: Cigna of CA PPO |
$5,647.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,487.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,487.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,487.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,052.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,052.80
|
| Rate for Payer: Galaxy Health WC |
$6,487.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,579.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,090.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$929.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,724.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,342.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,342.40
|
| Rate for Payer: Multiplan Commercial |
$6,105.60
|
| Rate for Payer: Networks By Design Commercial |
$4,960.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,487.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,579.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,816.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,816.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,816.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,816.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,487.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,487.20
|
| Rate for Payer: Vantage Medical Group Senior |
$6,487.20
|
|
|
HC CRYABLATION BONE
|
Facility
|
IP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,097.60 |
| Max. Negotiated Rate |
$13,164.80 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,195.20
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,900.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,587.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| Rate for Payer: Multiplan Commercial |
$12,390.40
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
|
|
HC CRYABLATION BONE
|
Facility
|
IP
|
$15,488.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
909020151
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,097.60 |
| Max. Negotiated Rate |
$13,164.80 |
| Rate for Payer: Adventist Health Commercial |
$3,097.60
|
| Rate for Payer: Cash Price |
$6,969.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,195.20
|
| Rate for Payer: Galaxy Health WC |
$13,164.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,292.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,330.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,900.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,587.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,717.12
|
| Rate for Payer: Multiplan Commercial |
$12,390.40
|
| Rate for Payer: Networks By Design Commercial |
$10,067.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,164.80
|
|
