|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$256.23
|
| Rate for Payer: Blue Shield of California EPN |
$169.29
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$255.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC LEUK ALK PHOS
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$84.92 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.92
|
| Rate for Payer: Blue Shield of California Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.61
|
| Rate for Payer: EPIC Health Plan Senior |
$8.60
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.97
|
| Rate for Payer: United Healthcare All Other HMO |
$6.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.60
|
|
|
HC LEUK ALK PHOS
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 85540
|
| Hospital Charge Code |
900910059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Adventist Health Commercial |
$98.80
|
| Rate for Payer: Cash Price |
$222.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.60
|
| Rate for Payer: EPIC Health Plan Senior |
$197.60
|
| Rate for Payer: Galaxy Health WC |
$419.90
|
| Rate for Payer: Global Benefits Group Commercial |
$296.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$329.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Networks By Design Commercial |
$321.10
|
| Rate for Payer: Prime Health Services Commercial |
$419.90
|
|
|
HC LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC LEUKEMIA/LYMPHOMA PANEL,EA MAR
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901931
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.32
|
| Rate for Payer: Blue Shield of California Commercial |
$139.15
|
| Rate for Payer: Blue Shield of California EPN |
$91.94
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.80
|
| Rate for Payer: Vantage Medical Group Senior |
$176.80
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Senior |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC LEUKOCYTES FECAL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
900911641
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC LEVEEN SHUNT PATENCY TEST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 78291
|
| Hospital Charge Code |
909301414
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$237.06 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$808.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$757.19
|
| Rate for Payer: Blue Shield of California Commercial |
$754.60
|
| Rate for Payer: Blue Shield of California EPN |
$498.13
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$51.85 |
| Rate for Payer: Adventist Health Commercial |
$12.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.81
|
| Rate for Payer: Blue Shield of California EPN |
$26.96
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cash Price |
$27.45
|
| Rate for Payer: Cigna of CA HMO |
$39.04
|
| Rate for Payer: Cigna of CA PPO |
$45.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$51.85
|
| Rate for Payer: Global Benefits Group Commercial |
$36.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Networks By Design Commercial |
$39.65
|
| Rate for Payer: Prime Health Services Commercial |
$51.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC LEVEL I-GROSS EXAM ONLY
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.40 |
| Max. Negotiated Rate |
$201.45 |
| Rate for Payer: Adventist Health Commercial |
$47.40
|
| Rate for Payer: Cash Price |
$106.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.80
|
| Rate for Payer: EPIC Health Plan Senior |
$94.80
|
| Rate for Payer: Galaxy Health WC |
$201.45
|
| Rate for Payer: Global Benefits Group Commercial |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.88
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Networks By Design Commercial |
$154.05
|
| Rate for Payer: Prime Health Services Commercial |
$201.45
|
|
|
HC LEVEL II-GROSS & MICRO EXAM
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$421.60 |
| Rate for Payer: Adventist Health Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$198.40
|
| Rate for Payer: EPIC Health Plan Senior |
$198.40
|
| Rate for Payer: Galaxy Health WC |
$421.60
|
| Rate for Payer: Global Benefits Group Commercial |
$297.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.04
|
| Rate for Payer: Multiplan Commercial |
$396.80
|
| Rate for Payer: Networks By Design Commercial |
$322.40
|
| Rate for Payer: Prime Health Services Commercial |
$421.60
|
|
|
HC LEVEL II-GROSS & MICRO EXAM
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800058
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$81.79 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.02
|
| Rate for Payer: Blue Shield of California Commercial |
$50.17
|
| Rate for Payer: Blue Shield of California EPN |
$33.15
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
HC LEVEL III- GROSS & MICRO EXAM
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800059
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$111.34 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.09
|
| Rate for Payer: Blue Shield of California Commercial |
$70.25
|
| Rate for Payer: Blue Shield of California EPN |
$46.41
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC LEVEL III PG
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800203
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$111.34 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.09
|
| Rate for Payer: Blue Shield of California Commercial |
$71.58
|
| Rate for Payer: Blue Shield of California EPN |
$47.29
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$68.48
|
| Rate for Payer: Cigna of CA PPO |
$79.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| 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: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC LEVEL III PG
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
903800203
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$66.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
|
|
HC LEVEL II PG
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Senior |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC LEVEL II PG
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
903800202
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Adventist Health Commercial |
$21.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.02
|
| Rate for Payer: Blue Shield of California Commercial |
$70.25
|
| Rate for Payer: Blue Shield of California EPN |
$46.41
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC LEVEL I PG
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.00
|
| Rate for Payer: Blue Shield of California Commercial |
$95.67
|
| Rate for Payer: Blue Shield of California EPN |
$63.21
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC LEVEL I PG
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
903800201
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$133.26 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.26
|
| Rate for Payer: Blue Shield of California Commercial |
$91.65
|
| Rate for Payer: Blue Shield of California EPN |
$60.55
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| 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: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC LEVEL IV-GROSS & MICRO EXAM
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$793.90 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Senior |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$578.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.16
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
|
|
HC LEVEL IV PG
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$133.26 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.26
|
| Rate for Payer: Blue Shield of California Commercial |
$95.67
|
| Rate for Payer: Blue Shield of California EPN |
$63.21
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| 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: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
