|
HC ACCS BIO SELECTRA HOOK 375529
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$539.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$474.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$575.55
|
| Rate for Payer: Blue Shield of California Commercial |
$598.78
|
| Rate for Payer: Blue Shield of California EPN |
$391.02
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Central Health Plan Commercial |
$784.00
|
| Rate for Payer: Cigna of CA HMO |
$627.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.00
|
| Rate for Payer: InnovAge PACE Commercial |
$490.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$686.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$686.00
|
| Rate for Payer: Multiplan Commercial |
$735.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
| Rate for Payer: Riverside University Health System MISP |
$392.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$588.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$490.00
|
| Rate for Payer: United Healthcare All Other HMO |
$490.00
|
| Rate for Payer: United Healthcare HMO Rider |
$490.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$490.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$833.00
|
| Rate for Payer: Vantage Medical Group Senior |
$833.00
|
|
|
HC ACCS BIO SELECTRA HOOK 375529
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT C1893
|
| Hospital Charge Code |
906812743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Cash Price |
$539.00
|
| Rate for Payer: Central Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$882.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.00
|
| Rate for Payer: Multiplan Commercial |
$735.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
|
|
HC ACCS BIO SELECTRA SLIT 383119
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC ACCS BIO SELECTRA SLIT 383119
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
906812744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC ACETAMINOPHEN (TYLENOL)
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
900911302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.74
|
| Rate for Payer: Blue Shield of California Commercial |
$47.95
|
| Rate for Payer: Blue Shield of California EPN |
$31.36
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Cash Price |
$43.45
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.16
|
| Rate for Payer: EPIC Health Plan Senior |
$18.64
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.64
|
| Rate for Payer: InnovAge PACE Commercial |
$27.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.98
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.64
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Prime Health Services Medicare |
$19.76
|
| Rate for Payer: Riverside University Health System MISP |
$20.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.10
|
| Rate for Payer: United Healthcare All Other HMO |
$15.10
|
| Rate for Payer: United Healthcare HMO Rider |
$15.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.50
|
| Rate for Payer: Vantage Medical Group Senior |
$18.64
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC ACETOACETATE, SEMIQUANTITATIVE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
900910466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$59.12 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.89
|
| Rate for Payer: Blue Shield of California EPN |
$16.28
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.03
|
| Rate for Payer: EPIC Health Plan Senior |
$8.17
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.17
|
| Rate for Payer: InnovAge PACE Commercial |
$12.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.95
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.17
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Prime Health Services Medicare |
$8.66
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.62
|
| Rate for Payer: United Healthcare All Other HMO |
$6.62
|
| Rate for Payer: United Healthcare HMO Rider |
$6.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.99
|
| Rate for Payer: Vantage Medical Group Senior |
$8.17
|
|
|
HC ACETYLCHOLINESTERASE STAIN
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,037.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$315.19
|
| 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 Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$315.03
|
| Rate for Payer: Blue Shield of California EPN |
$206.04
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: Cigna of CA HMO |
$332.16
|
| Rate for Payer: Cigna of CA PPO |
$384.06
|
| 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 |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: InnovAge PACE Commercial |
$1,556.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.17
|
| 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 |
$103.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,390.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,100.23
|
| Rate for Payer: Riverside University Health System MISP |
$1,141.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$311.40
|
| 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 ACETYLCHOLINESTERASE STAIN
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
903800020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$467.10 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$285.45
|
| Rate for Payer: Central Health Plan Commercial |
$415.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$207.60
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$467.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.80
|
| Rate for Payer: Multiplan Commercial |
$389.25
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$48.59 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.86
|
| Rate for Payer: Blue Shield of California Commercial |
$15.78
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Senior |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: InnovAge PACE Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.68
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.08
|
| Rate for Payer: Riverside University Health System MISP |
$7.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$35.81
|
| Rate for Payer: Blue Shield of California EPN |
$23.42
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Central Health Plan Commercial |
$47.20
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Senior |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$44.25
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.87
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC A.C. JOINTS
|
Facility
|
IP
|
$1,264.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.80 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.60
|
| Rate for Payer: EPIC Health Plan Senior |
$505.60
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$782.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
|
|
HC A.C. JOINTS
|
Facility
|
OP
|
$1,264.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Adventist Health Commercial |
$252.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$767.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.31
|
| Rate for Payer: Blue Shield of California Commercial |
$767.25
|
| Rate for Payer: Blue Shield of California EPN |
$501.81
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,011.20
|
| Rate for Payer: Cigna of CA HMO |
$808.96
|
| Rate for Payer: Cigna of CA PPO |
$935.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,074.40
|
| Rate for Payer: Global Benefits Group Commercial |
$758.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,137.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: Networks By Design Commercial |
$821.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,074.40
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$758.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$758.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
IP
|
$137,547.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$27,509.40 |
| Max. Negotiated Rate |
$123,792.30 |
| Rate for Payer: Adventist Health Commercial |
$27,509.40
|
| Rate for Payer: Cash Price |
$75,650.85
|
| Rate for Payer: Cash Price |
$75,650.85
|
| Rate for Payer: Central Health Plan Commercial |
$110,037.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$55,018.80
|
| Rate for Payer: Galaxy Health WC |
$116,914.95
|
| Rate for Payer: Global Benefits Group Commercial |
$82,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123,792.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91,743.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52,405.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85,141.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,509.40
|
| Rate for Payer: Multiplan Commercial |
$103,160.25
|
| Rate for Payer: Networks By Design Commercial |
$89,405.55
|
| Rate for Payer: Prime Health Services Commercial |
$116,914.95
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
OP
|
$137,547.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$27,509.40 |
| Max. Negotiated Rate |
$123,792.30 |
| Rate for Payer: Adventist Health Commercial |
$27,509.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83,532.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116,914.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75,650.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103,160.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66,600.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80,781.35
|
| Rate for Payer: Blue Shield of California Commercial |
$84,041.22
|
| Rate for Payer: Blue Shield of California EPN |
$54,881.25
|
| Rate for Payer: Cash Price |
$75,650.85
|
| Rate for Payer: Central Health Plan Commercial |
$110,037.60
|
| Rate for Payer: Cigna of CA HMO |
$88,030.08
|
| Rate for Payer: Cigna of CA PPO |
$101,784.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116,914.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$116,914.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116,914.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$55,018.80
|
| Rate for Payer: Galaxy Health WC |
$116,914.95
|
| Rate for Payer: Global Benefits Group Commercial |
$82,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123,792.30
|
| Rate for Payer: InnovAge PACE Commercial |
$68,773.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91,743.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52,405.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$85,141.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,509.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96,282.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96,282.90
|
| Rate for Payer: Multiplan Commercial |
$103,160.25
|
| Rate for Payer: Networks By Design Commercial |
$89,405.55
|
| Rate for Payer: Prime Health Services Commercial |
$116,914.95
|
| Rate for Payer: Riverside University Health System MISP |
$55,018.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68,773.50
|
| Rate for Payer: United Healthcare All Other HMO |
$68,773.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68,773.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68,773.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116,914.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116,914.95
|
| Rate for Payer: Vantage Medical Group Senior |
$116,914.95
|
|
|
HC ACQ-DECEASED DONOR-KIDNEY
|
Facility
|
IP
|
$147,372.00
|
|
| Hospital Charge Code |
904700002
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$132,634.80 |
| Rate for Payer: Adventist Health Commercial |
$29,474.40
|
| Rate for Payer: Cash Price |
$81,054.60
|
| Rate for Payer: Cash Price |
$81,054.60
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58,948.80
|
| Rate for Payer: Galaxy Health WC |
$125,266.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88,423.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132,634.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98,297.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,148.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91,223.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,474.40
|
| Rate for Payer: Multiplan Commercial |
$110,529.00
|
| Rate for Payer: Networks By Design Commercial |
$95,791.80
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
|
|
HC ACQ-DECEASED DONOR-KIDNEY
|
Facility
|
OP
|
$147,372.00
|
|
| Hospital Charge Code |
904700002
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$132,634.80 |
| Rate for Payer: Adventist Health Commercial |
$29,474.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89,499.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81,054.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110,529.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,357.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,551.58
|
| Rate for Payer: Blue Shield of California Commercial |
$90,044.29
|
| Rate for Payer: Blue Shield of California EPN |
$58,801.43
|
| Rate for Payer: Cash Price |
$81,054.60
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: Cigna of CA HMO |
$94,318.08
|
| Rate for Payer: Cigna of CA PPO |
$109,055.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$125,266.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125,266.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58,948.80
|
| Rate for Payer: Galaxy Health WC |
$125,266.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88,423.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132,634.80
|
| Rate for Payer: InnovAge PACE Commercial |
$73,686.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98,297.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,148.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91,223.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,474.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103,160.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103,160.40
|
| Rate for Payer: Multiplan Commercial |
$110,529.00
|
| Rate for Payer: Networks By Design Commercial |
$95,791.80
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
| Rate for Payer: Riverside University Health System MISP |
$58,948.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88,423.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88,423.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$73,686.00
|
| Rate for Payer: United Healthcare All Other HMO |
$73,686.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73,686.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,686.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Senior |
$125,266.20
|
|
|
HC ACQ-DECEASED DONOR-LIVER
|
Facility
|
IP
|
$112,283.00
|
|
| Hospital Charge Code |
904700502
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$22,456.60 |
| Max. Negotiated Rate |
$101,054.70 |
| Rate for Payer: Adventist Health Commercial |
$22,456.60
|
| Rate for Payer: Cash Price |
$61,755.65
|
| Rate for Payer: Cash Price |
$61,755.65
|
| Rate for Payer: Central Health Plan Commercial |
$89,826.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$44,913.20
|
| Rate for Payer: Galaxy Health WC |
$95,440.55
|
| Rate for Payer: Global Benefits Group Commercial |
$67,369.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101,054.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74,892.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,779.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69,503.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,456.60
|
| Rate for Payer: Multiplan Commercial |
$84,212.25
|
| Rate for Payer: Networks By Design Commercial |
$72,983.95
|
| Rate for Payer: Prime Health Services Commercial |
$95,440.55
|
|
|
HC ACQ-DECEASED DONOR-LIVER
|
Facility
|
OP
|
$112,283.00
|
|
| Hospital Charge Code |
904700502
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$22,456.60 |
| Max. Negotiated Rate |
$101,054.70 |
| Rate for Payer: Adventist Health Commercial |
$22,456.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68,189.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95,440.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61,755.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84,212.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,367.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,943.81
|
| Rate for Payer: Blue Shield of California Commercial |
$68,604.91
|
| Rate for Payer: Blue Shield of California EPN |
$44,800.92
|
| Rate for Payer: Cash Price |
$61,755.65
|
| Rate for Payer: Central Health Plan Commercial |
$89,826.40
|
| Rate for Payer: Cigna of CA HMO |
$71,861.12
|
| Rate for Payer: Cigna of CA PPO |
$83,089.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95,440.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$95,440.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95,440.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$44,913.20
|
| Rate for Payer: Galaxy Health WC |
$95,440.55
|
| Rate for Payer: Global Benefits Group Commercial |
$67,369.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101,054.70
|
| Rate for Payer: InnovAge PACE Commercial |
$56,141.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74,892.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,779.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69,503.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,456.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78,598.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78,598.10
|
| Rate for Payer: Multiplan Commercial |
$84,212.25
|
| Rate for Payer: Networks By Design Commercial |
$72,983.95
|
| Rate for Payer: Prime Health Services Commercial |
$95,440.55
|
| Rate for Payer: Riverside University Health System MISP |
$44,913.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67,369.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67,369.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$56,141.50
|
| Rate for Payer: United Healthcare All Other HMO |
$56,141.50
|
| Rate for Payer: United Healthcare HMO Rider |
$56,141.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56,141.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95,440.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95,440.55
|
| Rate for Payer: Vantage Medical Group Senior |
$95,440.55
|
|
|
HC ACQ-DECEASED DONOR-PANCREAS
|
Facility
|
OP
|
$93,569.00
|
|
| Hospital Charge Code |
904701001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$18,713.80 |
| Max. Negotiated Rate |
$84,212.10 |
| Rate for Payer: Adventist Health Commercial |
$18,713.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56,824.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51,462.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70,176.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,306.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54,953.07
|
| Rate for Payer: Blue Shield of California Commercial |
$57,170.66
|
| Rate for Payer: Blue Shield of California EPN |
$37,334.03
|
| Rate for Payer: Cash Price |
$51,462.95
|
| Rate for Payer: Central Health Plan Commercial |
$74,855.20
|
| Rate for Payer: Cigna of CA HMO |
$59,884.16
|
| Rate for Payer: Cigna of CA PPO |
$69,241.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$79,533.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79,533.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37,427.60
|
| Rate for Payer: Galaxy Health WC |
$79,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$56,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,212.10
|
| Rate for Payer: InnovAge PACE Commercial |
$46,784.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,410.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,649.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,919.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,713.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$65,498.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$65,498.30
|
| Rate for Payer: Multiplan Commercial |
$70,176.75
|
| Rate for Payer: Networks By Design Commercial |
$60,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$79,533.65
|
| Rate for Payer: Riverside University Health System MISP |
$37,427.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,784.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46,784.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46,784.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,784.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79,533.65
|
| Rate for Payer: Vantage Medical Group Senior |
$79,533.65
|
|
|
HC ACQ-DECEASED DONOR-PANCREAS
|
Facility
|
IP
|
$93,569.00
|
|
| Hospital Charge Code |
904701001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$18,713.80 |
| Max. Negotiated Rate |
$84,212.10 |
| Rate for Payer: Adventist Health Commercial |
$18,713.80
|
| Rate for Payer: Cash Price |
$51,462.95
|
| Rate for Payer: Cash Price |
$51,462.95
|
| Rate for Payer: Central Health Plan Commercial |
$74,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37,427.60
|
| Rate for Payer: Galaxy Health WC |
$79,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$56,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,212.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,410.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,649.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,919.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,713.80
|
| Rate for Payer: Multiplan Commercial |
$70,176.75
|
| Rate for Payer: Networks By Design Commercial |
$60,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$79,533.65
|
|
|
HC ACQ-LIVE DONOR-KIDNEY
|
Facility
|
OP
|
$147,372.00
|
|
| Hospital Charge Code |
904700001
|
|
Hospital Revenue Code
|
811
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$132,634.80 |
| Rate for Payer: Adventist Health Commercial |
$29,474.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89,499.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81,054.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110,529.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,357.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86,551.58
|
| Rate for Payer: Blue Shield of California Commercial |
$90,044.29
|
| Rate for Payer: Blue Shield of California EPN |
$58,801.43
|
| Rate for Payer: Cash Price |
$81,054.60
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: Cigna of CA HMO |
$94,318.08
|
| Rate for Payer: Cigna of CA PPO |
$109,055.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$125,266.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125,266.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58,948.80
|
| Rate for Payer: Galaxy Health WC |
$125,266.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88,423.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132,634.80
|
| Rate for Payer: InnovAge PACE Commercial |
$73,686.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98,297.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,148.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91,223.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,474.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103,160.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103,160.40
|
| Rate for Payer: Multiplan Commercial |
$110,529.00
|
| Rate for Payer: Networks By Design Commercial |
$95,791.80
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
| Rate for Payer: Riverside University Health System MISP |
$58,948.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88,423.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88,423.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$73,686.00
|
| Rate for Payer: United Healthcare All Other HMO |
$73,686.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73,686.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,686.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Senior |
$125,266.20
|
|
