|
HC SPCL TRT PROC LG SGL RAD DOSE
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
909100313
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$220.86 |
| Max. Negotiated Rate |
$3,769.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$617.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,533.80
|
| Rate for Payer: Blue Distinction Transplant |
$2,661.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,621.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,080.02
|
| Rate for Payer: Cash Price |
$1,995.75
|
| Rate for Payer: Cash Price |
$1,995.75
|
| Rate for Payer: Cash Price |
$1,995.75
|
| Rate for Payer: Cigna of CA HMO |
$2,838.40
|
| Rate for Payer: Cigna of CA PPO |
$3,281.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$3,769.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,326.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,206.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$3,548.00
|
| Rate for Payer: Networks By Design Commercial |
$2,882.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,769.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,661.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC SPEC DOSIMETRY-TLD MICRO
|
Facility
|
OP
|
$1,097.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
904810814
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$101.46 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.70
|
| Rate for Payer: Blue Distinction Transplant |
$658.20
|
| Rate for Payer: Blue Shield of California Commercial |
$648.33
|
| Rate for Payer: Blue Shield of California EPN |
$514.49
|
| Rate for Payer: Cash Price |
$493.65
|
| Rate for Payer: Cash Price |
$493.65
|
| Rate for Payer: Cash Price |
$493.65
|
| Rate for Payer: Cigna of CA HMO |
$702.08
|
| Rate for Payer: Cigna of CA PPO |
$811.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$932.45
|
| Rate for Payer: Global Benefits Group Commercial |
$658.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$822.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: Networks By Design Commercial |
$713.05
|
| Rate for Payer: Prime Health Services Commercial |
$932.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$658.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC SPEC DOSIMETRY-TLD MICRO
|
Facility
|
IP
|
$1,097.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
904810814
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$263.28 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Cash Price |
$493.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.80
|
| Rate for Payer: Galaxy Health WC |
$932.45
|
| Rate for Payer: Global Benefits Group Commercial |
$658.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.28
|
| Rate for Payer: Multiplan Commercial |
$877.60
|
| Rate for Payer: Networks By Design Commercial |
$713.05
|
| Rate for Payer: Prime Health Services Commercial |
$932.45
|
|
|
HC SPEC GRAVITY HEMATOLOGY
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
900910178
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.68
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.22
|
| Rate for Payer: Dignity Health Media |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.82
|
| Rate for Payer: United Healthcare All Other HMO |
$2.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC SPECIAL STAINS, GROUP 1
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$511.89
|
| 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 |
$27.15
|
| Rate for Payer: Blue Distinction Transplant |
$90.60
|
| Rate for Payer: Blue Shield of California Commercial |
$97.55
|
| Rate for Payer: Blue Shield of California EPN |
$77.31
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| 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 |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$113.25
|
| 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 |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| 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 |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| 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 SPECIAL STAINS, GROUP 1
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$462.40 |
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$362.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.56
|
| Rate for Payer: Multiplan Commercial |
$435.20
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
|
|
HC SPECIAL STAINS GROUP 1 PG
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$511.89
|
| 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 |
$27.15
|
| Rate for Payer: Blue Distinction Transplant |
$88.80
|
| Rate for Payer: Blue Shield of California Commercial |
$95.61
|
| Rate for Payer: Blue Shield of California EPN |
$75.78
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| 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 |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.00
|
| 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 |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| 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 |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| 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 SPECIAL STAINS GROUP 1 PG
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
903800207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.24 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC SPECIAL STAINS, GROUP 2
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$420.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| 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 |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| 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 |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| 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 |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SPECIAL STAINS GROUP 2 PG
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$420.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Blue Distinction Transplant |
$57.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.37
|
| Rate for Payer: Blue Shield of California EPN |
$48.64
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cigna of CA HMO |
$60.80
|
| Rate for Payer: Cigna of CA PPO |
$70.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$71.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC SPECIAL STAINS GROUP 2 PG
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800208
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.00
|
| Rate for Payer: Galaxy Health WC |
$80.75
|
| Rate for Payer: Global Benefits Group Commercial |
$57.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$76.00
|
| Rate for Payer: Networks By Design Commercial |
$61.75
|
| Rate for Payer: Prime Health Services Commercial |
$80.75
|
|
|
HC SPECIMEN HANDLING
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
900910091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.33 |
| Max. Negotiated Rate |
$89.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.49
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.80
|
| Rate for Payer: Dignity Health Media |
$23.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.20
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23.80
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$1,714.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
909100213
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$738.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$826.21
|
| Rate for Payer: Blue Distinction Transplant |
$1,028.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.97
|
| Rate for Payer: Blue Shield of California EPN |
$803.87
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cigna of CA HMO |
$1,096.96
|
| Rate for Payer: Cigna of CA PPO |
$1,268.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,456.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,285.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,371.20
|
| Rate for Payer: Networks By Design Commercial |
$1,114.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
IP
|
$1,714.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
904810802
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$411.36 |
| Max. Negotiated Rate |
$1,456.90 |
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.60
|
| Rate for Payer: Galaxy Health WC |
$1,456.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.36
|
| Rate for Payer: Multiplan Commercial |
$1,371.20
|
| Rate for Payer: Networks By Design Commercial |
$1,114.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.90
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
OP
|
$1,714.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
904810802
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$738.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$826.21
|
| Rate for Payer: Blue Distinction Transplant |
$1,028.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.97
|
| Rate for Payer: Blue Shield of California EPN |
$803.87
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: Cigna of CA HMO |
$1,096.96
|
| Rate for Payer: Cigna of CA PPO |
$1,268.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,456.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,285.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,371.20
|
| Rate for Payer: Networks By Design Commercial |
$1,114.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,028.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC SPEC PHYSICS CONSULT
|
Facility
|
IP
|
$1,714.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
909100213
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$411.36 |
| Max. Negotiated Rate |
$1,456.90 |
| Rate for Payer: Cash Price |
$771.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$685.60
|
| Rate for Payer: Galaxy Health WC |
$1,456.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,028.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.36
|
| Rate for Payer: Multiplan Commercial |
$1,371.20
|
| Rate for Payer: Networks By Design Commercial |
$1,114.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,456.90
|
|
|
HC SPEC TELETH BEAM PLAN
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
904810812
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$155.25 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$379.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,200.59
|
| Rate for Payer: Blue Distinction Transplant |
$2,220.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,186.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,735.30
|
| Rate for Payer: Cash Price |
$1,665.00
|
| Rate for Payer: Cash Price |
$1,665.00
|
| Rate for Payer: Cash Price |
$1,665.00
|
| Rate for Payer: Cigna of CA HMO |
$2,368.00
|
| Rate for Payer: Cigna of CA PPO |
$2,738.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$3,145.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,220.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,775.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,467.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$2,960.00
|
| Rate for Payer: Networks By Design Commercial |
$2,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,145.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,220.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC SPEC TELETH BEAM PLAN
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
904810812
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$888.00 |
| Max. Negotiated Rate |
$3,145.00 |
| Rate for Payer: Cash Price |
$1,665.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,480.00
|
| Rate for Payer: Galaxy Health WC |
$3,145.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,220.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,467.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,409.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$888.00
|
| Rate for Payer: Multiplan Commercial |
$2,960.00
|
| Rate for Payer: Networks By Design Commercial |
$2,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,145.00
|
|
|
HC SPEECH & LANG INDIV TRT
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000460
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$458.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$437.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$477.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: Cigna of CA HMO |
$508.80
|
| Rate for Payer: Cigna of CA PPO |
$588.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$675.75
|
| Rate for Payer: Dignity Health Media |
$675.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$675.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$596.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$675.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$675.75
|
| Rate for Payer: Vantage Medical Group Senior |
$675.75
|
|
|
HC SPEECH & LANG INDIV TRT
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
908600394
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$56.47 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$458.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$349.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$349.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$381.60
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$407.04
|
| Rate for Payer: Cigna of CA PPO |
$470.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$540.60
|
| Rate for Payer: Dignity Health Media |
$540.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$540.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$540.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$540.60
|
| Rate for Payer: Vantage Medical Group Senior |
$540.60
|
|
|
HC SPEECH & LANG INDIV TRT
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
907000460
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$675.75 |
| Rate for Payer: Cash Price |
$357.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.00
|
| Rate for Payer: Galaxy Health WC |
$675.75
|
| Rate for Payer: Global Benefits Group Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Networks By Design Commercial |
$516.75
|
| Rate for Payer: Prime Health Services Commercial |
$675.75
|
|
|
HC SPEECH & LANG INDIV TRT
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
908600394
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$152.64 |
| Max. Negotiated Rate |
$540.60 |
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.40
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
|
|
HC SPINAL LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$2,404.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
909000180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$2,043.40 |
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$961.60
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$915.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.96
|
| Rate for Payer: Multiplan Commercial |
$1,923.20
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
|
|
HC SPINAL LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$2,404.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
901200039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.63 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,442.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cash Price |
$1,081.80
|
| Rate for Payer: Cigna of CA PPO |
$1,778.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,043.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,442.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,803.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,603.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$576.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$1,923.20
|
| Rate for Payer: Networks By Design Commercial |
$1,562.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,043.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,442.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
