|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.38 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$115.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$184.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$197.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$197.40
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RAPID RHINO 4.5CM W/OUT AIRWAY
|
Facility
|
OP
|
$256.90
|
|
| Hospital Charge Code |
901607371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$218.37 |
| Rate for Payer: Adventist Health Commercial |
$51.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$168.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$218.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.76
|
| Rate for Payer: Cash Price |
$141.29
|
| Rate for Payer: Cigna of CA HMO |
$164.42
|
| Rate for Payer: Cigna of CA PPO |
$190.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$218.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$218.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.76
|
| Rate for Payer: EPIC Health Plan Senior |
$102.76
|
| Rate for Payer: Galaxy Health WC |
$218.37
|
| Rate for Payer: Global Benefits Group Commercial |
$154.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$179.83
|
| Rate for Payer: Multiplan Commercial |
$205.52
|
| Rate for Payer: Networks By Design Commercial |
$166.99
|
| Rate for Payer: Prime Health Services Commercial |
$218.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.45
|
| Rate for Payer: United Healthcare All Other HMO |
$128.45
|
| Rate for Payer: United Healthcare HMO Rider |
$128.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$128.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$218.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.37
|
| Rate for Payer: Vantage Medical Group Senior |
$218.37
|
|
|
HC RAPID RHINO 4.5CM W/OUT AIRWAY
|
Facility
|
IP
|
$256.90
|
|
| Hospital Charge Code |
901607371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$218.37 |
| Rate for Payer: Adventist Health Commercial |
$51.38
|
| Rate for Payer: Cash Price |
$141.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.76
|
| Rate for Payer: EPIC Health Plan Senior |
$102.76
|
| Rate for Payer: Galaxy Health WC |
$218.37
|
| Rate for Payer: Global Benefits Group Commercial |
$154.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$171.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.66
|
| Rate for Payer: Multiplan Commercial |
$205.52
|
| Rate for Payer: Networks By Design Commercial |
$166.99
|
| Rate for Payer: Prime Health Services Commercial |
$218.37
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$333.20 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.75
|
| Rate for Payer: Blue Shield of California Commercial |
$262.25
|
| Rate for Payer: Blue Shield of California EPN |
$173.26
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$313.60
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| 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: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$333.20 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$156.80
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.08
|
| Rate for Payer: Multiplan Commercial |
$313.60
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.80 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.76
|
| Rate for Payer: Multiplan Commercial |
$479.20
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$509.15 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$392.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.65
|
| Rate for Payer: Blue Shield of California Commercial |
$400.73
|
| Rate for Payer: Blue Shield of California EPN |
$264.76
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cigna of CA HMO |
$383.36
|
| Rate for Payer: Cigna of CA PPO |
$443.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$479.20
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$359.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$690.20 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$532.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$498.65
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cigna of CA HMO |
$519.68
|
| Rate for Payer: Cigna of CA PPO |
$600.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$690.20 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Senior |
$324.80
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$502.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.88
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
|
|
HC RCP ASSESS/EVAL/INTERVENTION
|
Facility
|
OP
|
$127.00
|
|
| Hospital Charge Code |
908600215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$107.95 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$95.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.99
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: Cigna of CA HMO |
$81.28
|
| Rate for Payer: Cigna of CA PPO |
$93.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.80
|
| Rate for Payer: EPIC Health Plan Senior |
$50.80
|
| Rate for Payer: Galaxy Health WC |
$107.95
|
| Rate for Payer: Global Benefits Group Commercial |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.90
|
| Rate for Payer: Multiplan Commercial |
$101.60
|
| Rate for Payer: Networks By Design Commercial |
$82.55
|
| Rate for Payer: Prime Health Services Commercial |
$107.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.50
|
| Rate for Payer: United Healthcare All Other HMO |
$63.50
|
| Rate for Payer: United Healthcare HMO Rider |
$63.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.95
|
| Rate for Payer: Vantage Medical Group Senior |
$107.95
|
|
|
HC RCP ASSESS/EVAL/INTERVENTION
|
Facility
|
IP
|
$127.00
|
|
| Hospital Charge Code |
908600215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$107.95 |
| Rate for Payer: Adventist Health Commercial |
$25.40
|
| Rate for Payer: Cash Price |
$69.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.80
|
| Rate for Payer: EPIC Health Plan Senior |
$50.80
|
| Rate for Payer: Galaxy Health WC |
$107.95
|
| Rate for Payer: Global Benefits Group Commercial |
$76.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$101.60
|
| Rate for Payer: Networks By Design Commercial |
$82.55
|
| Rate for Payer: Prime Health Services Commercial |
$107.95
|
|
|
HC RCP CONF PARTICIPATION
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908600216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC RCP CONF PARTICIPATION
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908600216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$21.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$893.35 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$683.15
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$893.35 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$689.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$788.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$359.75
|
| Rate for Payer: Blue Shield of California Commercial |
$643.21
|
| Rate for Payer: Blue Shield of California EPN |
$424.60
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cash Price |
$578.05
|
| Rate for Payer: Cigna of CA HMO |
$672.64
|
| Rate for Payer: Cigna of CA PPO |
$777.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$893.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$893.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.70
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$683.15
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$525.50
|
| Rate for Payer: United Healthcare All Other HMO |
$525.50
|
| Rate for Payer: United Healthcare HMO Rider |
$525.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$893.35
|
| Rate for Payer: Vantage Medical Group Senior |
$893.35
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$558.97
|
| Rate for Payer: Blue Shield of California Commercial |
$807.23
|
| Rate for Payer: Blue Shield of California EPN |
$532.88
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cigna of CA HMO |
$844.16
|
| Rate for Payer: Cigna of CA PPO |
$976.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.43
|
| Rate for Payer: United Healthcare All Other HMO |
$466.43
|
| Rate for Payer: United Healthcare HMO Rider |
$466.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.99 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.26
|
| Rate for Payer: Blue Shield of California Commercial |
$807.23
|
| Rate for Payer: Blue Shield of California EPN |
$532.88
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cigna of CA HMO |
$844.16
|
| Rate for Payer: Cigna of CA PPO |
$976.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$718.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.34
|
| Rate for Payer: Blue Shield of California Commercial |
$670.75
|
| Rate for Payer: Blue Shield of California EPN |
$442.78
|
| Rate for Payer: Cash Price |
$602.80
|
| Rate for Payer: Cash Price |
$602.80
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
